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An Ascaris went up in CBD of a 38yo female patient for 4 days which made her vomiting and epigastric pain. Ultrasound detected it and the worm was removed still alive by E R C P.
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ASCARIS into COMMON BILE DUCT
CASE REPORTDr PHAN THANH HAI
MEDIC MEDICAL CENTER, HCMC, VIETNAM
STORY• A 38YO WOMAN WENT THROUGH AN ACUTE EPIGASTRIC PAIN AND VOMITING FOR
4 DAYS.
• ABDOMINAL ULTRASOUND DETECTED A BIG GALL-BLADDER WITHOUT STONE, AND COMMON BILE DUCT (CBD) DILATED OF 1,5CM, WITH TUBULAR ECHOGENIC STRUCTURE INSIDE, NO SHADOWING LOOK LIKE AN ASCARIS WHICH WAS STILL ALIVE.
• ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PRESENTED A WORM INTO CBD THROUGH THE PAPILLA AND EXTRACTING IT BY SNAKE. ABDOMINAL SYMPTOMS HAS RESOLVED AND THE PATIENT REMAINS WELL WITHOUT SIGN OF CHOLANGITIS.
• AN ASCARIS STILL MOVES WEAKLY WHEN BEING OUT FROM CBD. BECAUSE HAVING A VULVAR WAIST AND NOT A HOOK AT ITS POSTERIOR, IT IS A FEMALE ADULT WORM.
• WHY DOES AN ADULT ASCARIS MOVE UP TO AN ECTOPIC PLACE (COMMON BILE DUCT INSTEAD OF JEJUNUM) ?
ABDOMINAL ULTRASOUND DETECTED A BIG GALL-BLADDER WITHOUT STONE, AND COMMON BILE DUCT DILATED OF 1,5CM, WITH TUBULAR ECHOGENIC STRUCTURE INSIDE, NO SHADOWING. A: Longitudinal section; B: Transversal section
ERCP presented a worm being in CBD and at the papilla, then extracting it out .
The female ascaris (because it has a vulvar waist) after removing from CBD still moving weakly.