Safra yolundaki askaris nedeniyle yapılan laparoskopik kolanjioskopi ( Olgu sunumu )

Abstract

Biliary ascariasis may cause biliary colic, cholecystitis, cholangitis, pancreatitis, haemobilia, biliary strictures or liver abscess. A 60-year-old woman presented with continuous upper abdominal pain and nausea. She had severe abdominal tenderness in the right upper quadrant. She had leukocytosis and laboratory work-up was otherwise normal. Ultrasonography revealed an immotile ascaris which could be possibly dead in the common bile duct. Endoscopic retrograde cholangiopancretography showed obstruction in the proximal biliary tree. Extraction was failed after endoscopic sphincterotomy. Since her abdominal pain and clinical findings persisted, she underwent laparoscopic bile duct exploration with cholangioscopy after magnetic resonance imaging. At cholangioscopy, the bile ducts seemed to be normal and it was concluded that the worm had been replaced down through the sphincterotomy during surgical dissection. The common bile duct was sutured continuously. Then a normal cholangiogram through the cystic duct was obtained and cholecystectomy was completed. Two days later a 23-cm-long ascaris passed in the stool. Hence biliary ascariasis may cause severe complications, particularly for the patients with a failed endoscopic intervention, laparoscopic approach may be considered as an appropriate method for treatment.