An unusual cause of cholecystitis
Laboratory test results at presentation revealed mildly increased liver enzymes aspartate transaminase:353 U/l, alanine transaminase:218mg/dl, packed cell volume:35.8%, and leucocyte count was 18109/l with mild eosinophilia. Serum amylase level was within normal limits at admittance. Her stool examination was positive
for A lumbricoides o Burberry Purses Outlet va. A sagittal ul Burberry Purses Outlet trasonographic image of the gall bladder showed a ribbon like, non shadowing structure with a highly echogenic
wall and a less echogenic centre. Gall bladder wall was 5 mm in thickness. The structure was 4 mm in diameter, and 5 cm in
length (fig 1).
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Cefotaxime was started intravenously with the diagnosis of acute cholecystitis. After her clinical status subsided, she began
receiving mebendazole orally 100 mg twice daily and continued for three days. On the eighth day of her admission, subcostal
pain of the patient recurred. Liver enzymes mildly increased and serum amylase level increased to 184 U/l. After her clinical
status subsided, on the 13th day of admittance, she underwent surgery. In operation, cholecystectomy and choledochus exploration
were performed. Any worm type of parasite was not detected in the gall bladder and biliary tract. But ascaris eggs were seen
in the microscopical examination of the bile samples taken from the gall bladder. She was uneventful in the postoperative
period and discharged nine days after surgery.
Although intestinal infestation of ascariasis is often asymptomatic, migration of worms into the biliary tree may cause serious
complications such as biliary colic, cholecystitis Burberry Purses Outlet , cholangitis, intrahepatic abscesses, or panc Burberry Purses Outlet reatitis. But, these complications
are rare even in endemic areas.2,3 Worms in the duodenum and invading the ampullary orifice induce biliary colic or acute pancreatitis and in the common bile
duct they usually block the cystic duct and cause distension of gall bladder, which lead to episodes of acute cholecystitis.2
The diagnosis of biliary ascariasis can be established by means of microscopical examination of ascaris eggs in the bile samples,
as represented in our case. Hepatobiliary ultrasonography is also a safe and non invasive procedure that permits the identification
of the roundworm, which moves and changes position while alive.2 5 A ribbon like, non shadowing structure with a highly echogenic wall and a less echogenic centre image at the sagittal ultrasonography
of the gall bladder is strongly demonstrated as a live ascaris in the gall bladder (fig 1).
Various drugs used for the treatment of intestinal ascariasis are not effective for biliary ascariasis, except for piperazine
citrate when instilled through a nasobiliary drain.5 Mebendazole is not effective because of little absorption from the intestinal tract. It usually requires laparotomy and cholecystectomy. But in some cases,