Ascaris lumbricoides and its invasion of the accessory cystic duct: An unusual presentation

Zain Majid, Irfan Masood, Muhammad Taqi Pirzada

Research output: Contribution to journalArticlepeer-review

Abstract

Around the world, Ascaris lumbricoides is the most common helminthic infection. We describe the case of a 25-year-old woman, known to have had Ascaris infestation, presenting with abdominal pain, constipation and jaundice together with fever and tachycardia. There was tenderness in the right hypochondrium and liver function tests confirmed cholestatic jaundice. An abdominal ultrasound showed multiple linear echogenic foci in the distal small intestine along with cholelithiasis and a thick-walled gall bladder with a single stone compressing the common bile duct (Mirizzi syndrome). The patient underwent exploratory laparotomy; more than 100 worms were found inside the small intestine and they were removed by enterotomy and manual decompression. No worm could be palpated within the common bile duct (CBD). Cholecystectomy was performed, during which an accessory cystic duct was noted opening into the common bile duct superiorly to the main cystic duct. A 10 cm live worm was found coming out of it and was removed via forceps. Later on an endoscopic retrograde cholangio-pancreatogram (ERCP) showed a widened ampulla, a mildly dilated common bile duct, but without any filling defects. The patient made an uneventful postoperative recovery being discharged on the ninth day. Worms in an accessory cystic duct have not been report in the medical literature so far.

Original languageEnglish (US)
Pages (from-to)129-131
Number of pages3
JournalTropical Doctor
Volume45
Issue number2
DOIs
StatePublished - Apr 2015
Externally publishedYes

Keywords

  • Accessory cystic duct
  • Ascaris
  • Invasion
  • tropical–subtropical areas

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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