Imaging Findings in Complicated Hepato-biliary Ascariasis: A Case Report

Abstract

Aim: To review the clinical presentation and demonstrate imaging findings in complicated Hepatobiliary Ascariasis (HBA) and its management. Presentation: A 45 years old male diabetic patient presented with the symptoms of fever, hiccoughs, abdominal bloating, nausea, and bilious vomiting lasting for 10 days with elevated bilirubin and Alkaline phosphatase levels.     Discussion: HBA arises from the migration of the intestinal parasite Ascaris lumbricoides from the duodenum into the biliary tree causing obstruction. HBA may present as, acute cholecystitis, biliary colic, pyogenic cholangitis, pancreatitis, obstructive jaundice, hepato-lithiasis and hepatic abscess. Significant morbidity and mortality are associated with HBA complications and hence early diagnosis and management is of utmost significance. Majority of cases are treated conservatively. Endoscopic withdrawal of Ascaris lumbricoides is feasible only upon the availability of expert endoscopy services and surgical removal if unavailable.  Conclusion: HBA though uncommon, it can direct to serious morbidity and mortality which necessitate early diagnosis of the disease. Clinical features of Ascariasis and laboratory tests are commonly non-specific. Multiple Imaging methods aids in morphological recognition of the roundworm, potential complications of HBA and treatment follow up.