engleski

Acute pancreatitis caused by Ascaris lumbricoides: a case report

A 77-year-old man with no medical history presented to the hospital with abdominal pain, nausea, vomiting, and jaundice, followed by fever up to 40°C. Physical examination showed only right upper quadrant tenderness. Laboratory test results included serum amylase of 890 U/L (reference range, 60-180 U/L), serum lipase of 1925 U/L (0-160 U/L), and total bilirubin of 105 μ mol/L (5.1-17 μ mol/L). Abdominal US showed gallbladder dilatation with wall thickening. A single-shot MRCP revealed a filling defect within the distal common bile duct mimicking a stone, a mildly intensive peripancreatic signal suggesting edema, and dark stripes surrounded with intestinal fluid in the small intestine (A). During the endoscopic evaluation of the upper tract en route to perform ERCP, multiple adult roundworms were found in the duodenum (B). ERCP showed a filling defect in the prepapillary section of the duodenum, and papillotomy was performed (C). After ERCP, EUS revealed that the common bile duct was obstructed by longitudinal hyperechogenic forms with intensively hyperechogenic edges (D). The diagnosis of acute pancreatitis caused by parasites inside the common bile duct was confirmed by stool analysis, which revealed eggs of Ascaris lumbricoides and Trichuris trichiura. The patient was treated with a 3-day course of mebendazole with good result.

pancreatitis; Ascaris lumbricoides

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