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| | CASE REPORT | | | | | Year : 2005 | Volume : 59 | Issue : 5 | Page : 208-210 | | | Magnetic resonace appearance of Gall Bladder Ascariasis
Prafull K Arya1, Ranjan Kukreti2, Muktanjali Arya3, Sachida N Gupta1
1 Departments of Surgery, Himalayan Institute of Medical Sciences, Jolly Grant -248140, Dehradun, India
2 Departments of Radiology, Himalayan Institute of Medical Sciences, Jolly Grant -248140, Dehradun, India
3 Departments of Microbiology, Himalayan Institute of Medical Sciences, Jolly Grant -248140, Dehradun, India
Correspondence Address:
Prafull K Arya
Department of Surgery, Himalayan Institute of Medical Sciences, Jolly Grant - 248140, Dehradun, Uttaranchal
India
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DOI: 10.4103/0019-5359.16257 PMID: 15985729 Ascariasis is a common disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas. Numerous studies have been published on biliary tract ascariasis. All these have documented ultrasonography as the primary imaging modality for biliary tract ascariasis. Magnetic Resonance Cholangiopancreatography (MRCP) has been the latest entrant for the study of bilary tract. MRCP findings of biliary tract ascariasis have been scarcely documented. MRCP is a unique non-invasive investigation for demonstrating ascariasis in Gall bladder and bilary tract clearly. We present MR appearances of Gall bladder and biliary tract in a proven case of biliary ascariasis.
Keywords: Gall Bladder, Biliary Tract, Ascariasis, MRCP
How to cite this article:
Arya PK, Kukreti R, Arya M, Gupta SN. Magnetic resonace appearance of Gall Bladder Ascariasis. Indian J Med Sci 2005;59:208-10 |
| ¤ Introduction | |  |
Ascariasis is a common intestinal parasitic disease in many developing countries and is a common cause of biliary and pancreatic diseases in endemic areas.[1],[2],[3] From duodenum it can enter biliary tract where it is associated with bilary colic and ascending cholangitis. Cholecytitis, pancreatitis, obstructive jaundice and septicemia are the other potential complications.[1],[2],[3],[4],[5],[6] Ultrasound is the investigation of choice for detection of biliary ascariasis.[2],[4] MRCP is being increasingly used for evaluation of Pancreato-biliary system. There are very few reports documenting MRCP findings in biliary ascariasis.[7] The MRCP findings in a proven case of biliary ascariasis are presented here. The role of MRCP in such cases is also briefly discussed vis a vis other imaging modalities.
| ¤ Case Report | | |
A 16 years old girl presented with obstructive jaundice, fever and pain. Ultrasound revealed gallstones and dilated common bile duct (CBD) with suggestion of bilary ascariasis. MRCP was done for further vevalua'tion.
The patient was subjected to MR examination on a 1.5 T Unit (Siemens Vision, Erlangen, Germany). Routine T2-weighted fat suppressed axial and coronal images were acquired which were followed by MR cholangiogram using TSE (Turbo Spin-Echo) and fat suppressed HASTE (Half Fourier Single-Shot Turbo Spin-Echo) sequences in the oblique, coronal and axial planes. These showed multiple linear/ tubular hypointense filling defects in the gall bladder and CBD, confirming the diagnosis of roundworms in gallbladder and bile duct, with a single calculus at the lower end of CBD [Figure - 1] and [Figure - 2]. Stool examination showed presence of Ascaris lumbricoides eggs. The patient was given a course of albendazole; subsequently she underwent cholecystectomy and choledocholithotomy. Gall bladder contained a few membranes of worms along with multiple stones. CBD was dilated (1.5 cm in calibre) and contained membranes of worms along with a single 1.2 cm size stone.
| ¤ Discussion | | |
Biliary ascariasis is a known cause of biliary and pancreatic system diseases in endemic areas.[1],[2],[3],[4],[5],[6] Ultrasonography has been routinely used for evaluation of biliary diseases due to ascariasis and is the investigation of choice.[2],[4] The only drawback that can be ascribed to ultrasonography is it's operator dependence. The diagnosis can be missed, and false positivity due to side-lobe artefacts can also occur in non-experienced hands. Moreover, the examination can be sub-optimal due to technical factors like obesity and excessive bowel gas.
ERCP is a good modality but it is invasive and has certain well known hazarads.[1] As a diagnostic modality MRCP has increased sensitivity over ERCP as gallbladder may fail to get visualized on ERCP specially if there is some blockage at Gall bladder neck. MRCP findings in present case of Biliary ascariasis are multiple linear/ tubular hypointense filling defects in the Gall bladder and CBD. The morphology and signal intensity of the structures in the Gall bladder is highly suggestive of roundworms, the linear hypointensity in CBD is somewhat less specific. However in conjuction with the findings in the Gall bladder lumen, the most likely interpretation is a worm in CBD.
MRCP has established a well accepted place for itself in the evaluation of pancreato-biliary system in general.[7] MRI is a safe procedure in pregnant patients also as there is no radiation exposure. The MRCP imaging features of biliary ascariasis need to be documented so that i) Incidental discovery of biliary ascariasis on MRCP, carried out for evaluation of pancreato-biliary system for other diseases, is registered and not missed or misinterpreted; and ii) In cases where optimal ultrasonography study is not feasible, patient may be evaluated by MRCP.
We conclude that the serpentine hypointense structures in gall bladder and CBD on MRCP should bring diagnosis of biliary ascariasis into consideration. The present case report is intended to strengthen the database regarding MRCP findings on biliary ascariasis.
| ¤ References | | |
| 1. | Khuroo MS, 0 Zargar SA.0 Biliary Ascariasis: A Common cause of biliary and pancreatic disease in an endemic area. Gastroentrology 1985;88:418-23.  | | 2. | Javid G, Wani N, Gulzar GM, Javid O, Khan B, Shah A. Gall bladder ascariasis: presentation and management. Br J Surg 1999;86:1526-7. [PUBMED] [FULLTEXT] | | 3. | Ochoa B. Surgical complications of ascariasis. World J Surg 1991;15:222-7. [PUBMED] | | 4. | Khuroo MS, 0 Zargar SA,0 Mahajan R, Bhat RL, 0 Javid G. Sonographic appearances in biliary Ascariasis. Gastroenterology 1987;93:267-72. | | 5. | Sandouk F, 0 Haffar S, 0 Zada MM, 0 Graham DY, 0 Anand BS. 0 Pancreatic-biliary Ascariasis: Experience of 300 cases. Am J of Gastroenterol 1997;92:2264-7. | | 6. | Cremin BJ. 0 Biliary parasites. Br J Radiol 1969;42:506-8. | | 7. | Ng KK, Wong HF, Kong MS, Chiu LC, Tan CF, Wan YL. Biliary ascariasis: CT, MR cholangiopancreatography, and navigator endoscopic appearance-report of a case of acute biliary obstruction. Abdom Imaging 1999;24:470-2. [PUBMED] [FULLTEXT] |
Figures [Figure - 1], [Figure - 2]
| This article has been cited by | | 1 | Successful Elimination of Ascaris lumbricoides from the Gallbladder by Conservative Medical Therapy | | | Manish Kumar Misra,Sarabjeet Singh,Tripta Sethi Bhagat | | Indian Journal of Surgery. 2013; 75(S1): 379 | | [Pubmed] | | | 2 | Magnetic resonance demonstration of gall bladder ascariasis | | | Gaurav Mittal, Ranjana Gupta, Puneet Mittal | | Indian Journal of Gastroenterology. 2011; | | [VIEW] | | | 3 | Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report | | | Kaji, K., Yoshiji, H., Yoshikawa, M., Yamazaki, M., Ikenaka, Y., Noguchi, R., Sawai, M., (...), Fukui, H. | | World Journal of Gastroenterology. 2007; 13(27): 3760-3762 | | [Pubmed] | | | 4 | Biliary ascariasis: Report of a complicated case and literature review | | | Sanai, F.M., Al-Karawi, M.A. | | Saudi J Gastroenterol. 2007; 13(1): 25-32 | | [Pubmed] | |
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