Biliary Ascariasis- Experience from a Tertiary Care Hospital in Kashmir Valley, India

Abstract

Background: Hepatobiliary ascariasis is usually endemic in socioeconomically underdeveloped countries and in certain geographical areas which favor the survival of this nematode. In India, ascariasis is highly prevalent in Kashmir valley a northern temperate region. Methods: A total of 70 patients attending general surgery department of SMHS hospital Srinagar, Kashmir, India with biliary ascariasis were included in the study. All the patients were clinically assessed and depending upon the severity of condition, patients were either managed by conservative method or by surgical manipulation. Results: In this study majority of the patients presenting biliary ascariasis were females (60%) and the most common age group affected was below 30 years of age. Pain in right hypochondrium was the most common presentation in all patients. Most of the patients (90%) were successfully managed by conservative treatment. The worm usually returned to the intestine and only in some cases, some therapeutic interventions like Endoscopic retrograde cholangiopancreatography (ERCP) or surgical management were required. Conclusion: Biliary ascariasis may present with biliary colic or with various complications like cholangitis, acute pancreatitis, liver abscess, etc. Biliary ascariasis in child and outpatient family clinics can be managed by administration of anti-helminth drugs to the affected and susceptible population. Sonography has been shown to have a high diagnostic accuracy in the diagnosis. Most of the patients can usually be managed conservatively, and surgery or ERCP are required only in a very limited number of cases.