Massive Hepatobiliary and Pancreatic Ascariasis with Impending Liver Abscesses - A Case Report Analysis

Ascariasis caused by the nematode Ascaris lumbricoides is a very common disorder amongst the Asian population and as many as 1.5 to 2 billion people are affected worldwide. Their agility often takes them through different orifices into ducts and cavities. Hepatobiliary and pancreatic ascariasis (HPA) refers to a group of diseases caused by migration of the Ascaris from the intestine into the biliary tree and pancreatic duct through the ampulla of Vater leading to a variety of complications such as biliary colic, gallstone formation, cholecystitis, pyogenic cholangitis, liver abscess and pancreatitis. Ultrasonography (USG) can be quick, safe, noninvasive and relatively inexpensive tool in diagnosing the presence of worms as linear filling defect and also evaluating response to treatment. ERCP is an excellent diagnostic tool for demonstrating the presence of parasites in the biliary tree. Furthermore, ERCP is also used in the therapy of biliary parasitic infestations and carries less morbidity and mortality than the surgical approach. We present a case of a 14 year girl who was diagnosed as a case of massive HPA with impending liver abscesses and responded to conservative management.