Bilary Ascariasis Cases Presentation With US Images

8/6/2019 Bilary Ascariasis Cases Presentation With US Images

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CaseCase

PresentationsPresentationsDr. M. Sajjad Ashraf Dr. M. Sajjad Ashraf

Department of Pediatric SurgeryDepartment of Pediatric SurgeryCivil Hospital KarachiCivil Hospital Karachi


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Case no. 1Case no. 1


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General ExaminationGeneral Examination

Ill looking, pale and toxic.Ill looking, pale and toxic.

H/R: H/R: 110 beats/ minute110 beats/ minuteR /R: R /R: 30 breaths/ minute30 breaths/ minuteTemperature : Temperature : 10 3 F10 3 F

Anemia : Anemia : +ve+ve


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Systemic ExaminationSystemic ExaminationAbdomen:Abdomen:

Tenderness in right hypochondriumTenderness in right hypochondriumLiver:Liver: Palpable 4 cm below costal marginPalpable 4 cm below costal margin Smooth and tender Smooth and tender Span 10 .5 cmSpan 10 .5 cm

Spleen not palpable.Spleen not palpable.No mass palpable.No mass palpable.Other Viscera normal.Other Viscera normal.

Gut sounds normally audible.Gut sounds normally audible.


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InvestigationsInvestigationsCBCCBCHbHb 6.8 gm%6.8 gm%

TLCTLC10

,900

/cmm10

,900

/cmmPlateletPlatelet 11 9, 000 /cmm11 9, 000 /cmm

ESR:ESR: 68 mm/ 1 hour 68 mm/ 1 hour RBS:RBS: 101 mg%101 mg%S. Calcium:S. Calcium: 7.9 mg%7.9 mg%UCE:UCE: Within normal limits.Within normal limits.


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LFTLFT

Total BilirubinTotal Bilirubin 1 .8 mg%1 .8 mg%Direct BilirubinDirect Bilirubin 1 .0 mg%1 .0 mg%

ALT ALT 1 3 U/L1 3 U/L

AST AST 44 U/L44 U/L Alkaline Phosphatase Alkaline Phosphatase 296 0296 0 U/LU/LGamma GTGamma GT 622 U/L622 U/L

PT:PT: 24 sec.24 sec.(14 sec.)(14 sec.)


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U/S AbdomenU/S Abdomen(13(13

thth

June 2005)June 2005)

M ultiple hypoM ultiple hypo- -echogenic areas seen in theechogenic areas seen in the

liver liver abscesses .abscesses .Linear tubular structures seen insideLinear tubular structures seen insidesuggesting presence of worms in thesuggesting presence of worms in theabscess cavity.abscess cavity.Worms seen in right hepatic duct, commonWorms seen in right hepatic duct, commonbile duct and bowel loops.bile duct and bowel loops.R est of the viscera are normal.R est of the viscera are normal.


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U/S AbdomenU/S Abdomen(21(21 stst June 2005)June 2005)

Abscess in right lobe of liver 8.8 cm x 5.7 Abscess in right lobe of liver 8.8 cm x 5.7

cm with worms inside.cm with worms inside.2 small abscesses 1 .4 cm x 0 .8 cm seen2 small abscesses 1 .4 cm x 0 .8 cm seenin left lobe.in left lobe.

Elongated echogenic structure (worm)Elongated echogenic structure (worm)seen in left hepatic duct.seen in left hepatic duct.Gall bladder, CBD & rest of visceraGall bladder, CBD & rest of visceranormal.normal.


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DiagnosisDiagnosis

M ultiple liver abscessM ultiple liver abscessSecondary to Biliary AscariasisSecondary to Biliary Ascariasis


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ProgressProgress

Clinical improvement in symptoms nextClinical improvement in symptoms next

daydayU/S Guided AspirationU/S Guided Aspiration (25(25 thth June)June) M arked healing response with abscess cavityM arked healing response with abscess cavity

filled with granulation tissue.filled with granulation tissue. Aspiration not feasible. Aspiration not feasible.


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Case no. 2Case no. 2


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2 year male child2 year male child

Presenting Complaints:Presenting Complaints:Colicky abdominal painColicky abdominal pain 3 days3 daysBilious Vomiting Bilious Vomiting 3 days3 days


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G eneral ExaminationG eneral Examination

I ll looking and irritable.I ll looking and irritable.

H/R:H/R: 120 beats/ minute120 beats/ minuteR/R:R/R: 30 breaths/ minute30 breaths/ minute

Temperature: Temperature: A/F A/F

Anemia: Anemia: +ve+ve Jaundice: Jaundice: +ve+veDehydration:Dehydration: +ve+ve


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S ystemic ExaminationS ystemic Examination Abdomen: Abdomen:

Tenderness in right hypochondrium and epigastrium. Tenderness in right hypochondrium and epigastrium.

Guarding: +veGuarding: +veLiver: not palpated because of guarding.Liver: not palpated because of guarding.Spleen not palpable.Spleen not palpable.No mass palpable.No mass palpable.Other Viscera normal.Other Viscera normal.Gut sounds audible.Gut sounds audible.


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I nvestigationsI nvestigationsCBCCBCHbHb 8.4 gm%8.4 gm%

TLC TLC 4,300 /cmm4,300 /cmmPlateletPlatelet 540,000 /cmm540,000 /cmm

U rea:U rea: 10 mg%10 mg%S. CreatinineS. Creatinine :: 0.5 mg%0.5 mg%S. Electrolytes:S. Electrolytes:NaNa 132 mEq/L132 mEq/LK K 3.0 mEq/L3.0 mEq/LClCl 95 mEq/L95 mEq/LHCO3HCO3 23 mg%23 mg%


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LFTLFT

Total Bilirubin Total Bilirubin 6.0 mg%6.0 mg%Direct BilirubinDirect Bilirubin 4.8 mg%4.8 mg% ALT ALT 148 U/L148 U/L AST AST 146 U/L146 U/L Alkaline Phosphatase Alkaline Phosphatase 21532153 U/LU/LGamma GTGamma GT 412 U/L412 U/L

P T :P T : 14 sec.14 sec.(14 sec.)(14 sec.)

S. Amylase:S. Amylase: 1150 U/L1150 U/L


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U/S AbdomenU/S Abdomen(20(20

thth

June 2005) June 2005)

Gall Bladder thick walled with multipleGall Bladder thick walled with multiple

elongated tubular structures (worms).elongated tubular structures (worms).Multiple worms seen in Biliary Tract.Multiple worms seen in Biliary Tract.CBD dilated.CBD dilated.

Pancreatic duct also shows a worm in itsPancreatic duct also shows a worm in itsterminal part.terminal part.


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D iagnosisD iagnosis

Acalculous Cholecystitis Acalculous Cholecystitisandand

PancreatitisPancreatitisSecondary to Biliary AscariasisSecondary to Biliary Ascariasis


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T reatment T reatmentNPONPO

I /V fluidsI /V fluids Anti Anti--bioticbiotic Anti Anti--spasmodicspasmodic

Analgesic Analgesic


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ProgressProgress

Significant Clinical improvement after 48 hours.Significant Clinical improvement after 48 hours.

Started orally.Started orally.Passed few Ascaris in stools.Passed few Ascaris in stools.Repeated U/S scan:Repeated U/S scan:

No worms in Biliary Tract, Pancreatic DuctNo worms in Biliary Tract, Pancreatic Ductand Gall bladder.and Gall bladder.


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Bilary Ascariasis Cases Presentation With US Images