Endoscopy 2018; 50(04): S184-S185
DOI: 10.1055/s-0038-1637603
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

PANCREATIC ASCARIASIS: CASE SERIES

P Somani
1   Jaswant Rai Specilaity Hospital, Department of Gastroenterology, Meerut, India
,
M Sharma
1   Jaswant Rai Specilaity Hospital, Department of Gastroenterology, Meerut, India
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Although uncommon in West, Ascaris lumbricoides is common cause of acute pancreatitis in developing countries. Pancreatic ascariasis is a rare entity. We present retrospective data of 10 years of 15 cases of pancreatic ascariasis.

Methods:

During study period of 10 years, 15 cases of pancreatic ascariasis were diagnosed by USG/EUS. EUS was performed with a linear or radial echoendoscope. 13 patients presented with symptoms of acute pancreatitis. Out of 13 patients, 9 presented with first episode of idiopathic pancreatitis while 4 presented with idiopathic recurrent acute pancreatitis (IRAP). One patient had biliary colic and one patient presented with acute cholangitis. 12 patients had mild pancreatitis while only one had moderate pancreatitis. Only 2 cases were diagnosed with USG while 13 patients were diagnosed with EUS. Out of 15 patients, 14 underwent side viewing endoscopy with removal of live single/multiple worms with rat tooth forceps/biopsy forceps/dormia basket in 13 patients. 2 patients were managed conservatively with repeat USG showing absence of ascariasis. There were no complications.

Results:

2 patients had associated bile duct ascariasis. EUS features were single or multiple linear hyperechoic structure without acoustic shadowing in the PD or CBD or with central hypoechoic tube representing alimentary canal of the worm and movements of worms inside the duct. Live roundworms were removed from CBD and PD without undertaking sphincterotomy. In endemic areas, sphincterotomy facilitates the risk of migration of worms into the CBD.

Conclusions:

Ascariasis induced acute pancreatitis is mild and EUS is the investigation of choice. The recurrence is rare and treatment is side viewing endoscopy with removal of worms. Although USG is quite sensitive for diagnosing biliary and pancreatic ascariasis, its sensitivity significantly falls when the worm is thin, in the PD, or the CBD is non-dilated. EUS should be used early in the work-up of IAP after the first episode.