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| Year : 1983 | Volume
: 29
| Issue : 2 | Page : 126-8 |
Ascariasis of the gall bladder (a case report).
Ahmed MN, Saleema , Shant MS, Misgar MS, Zargar HH
How to cite this article:
Ahmed M N, Saleema, Shant M S, Misgar M S, Zargar H H. Ascariasis of the gall bladder (a case report). J Postgrad Med 1983;29:126 |
Ascaris lumbricoides is believed to be the most common intestinal parasite found in man.[4] Though intestinal obstruction is the most commonly encountered surgical complication resulting from the presence of the worms in the intestinal tract, any of the organs of the body may become the seat of severe and often fatal disease. The migration of the parasite has long been recognised and presents a very dangerous aspect of ascariasis. Cases are on record in which this parasite has been found in gall bladder, biliary ducts, liver, pancreatic duct, urinary passages, fallopian tubes and even in the heart.[1] Herein, we present one case in whom a dead round work was removed from a Ironically inflammed gall bladder.
GQ, a 19 year old, Muslim, boy was admitted in the surgical services of S.M.H.S. Hospital Srinagar, Kashmir, with complaints of colicky upper abdominal pain, vomiting of worms and fever with rigors and chills of six days' duration. Past history revealed similar complaints one year back. There were no symptoms suggestive of peptic ulcer disease. There was no history of jaundice. The patient had never received a vermifuge. Examination revealed an averagely built boy with slight pallor, no jaundice or lymphadenopathy. Pulse was 108 per minute; temperature, 1000F; respiration, 26 per minute and B.P. 100/70 mm of Hg. Local examination revealed a non-distended abdomen having localized tenderness m the right upper quadrant with mild rigidity, but no lump was palpable. There was no visceromegaly and no free fluid in the abdomen. Bowel sounds were normal and per rectal examination revealed no abnormality. Rest of the systemic examination was also normal.
Laboratory examination revealed the following: Haemoglobin was 10.6 g%; Total leucocyte count was 13400 per cmm with P-75%, L-20% and E-5%: Urine analysis was normal. Liver function tests showed bilirubin of 0.3 mg%, albumin, 4.2 Gm%, globulin, 3.2 Gm% and total proteins 7.4 Gm%. Serum alkaline phosphatase was 8 K.A. units.
Serum amylase was within normal limits. Plain X-ray of the abdomen did not reveal any radio-opaque shadow or any free gas under the right dome of diaphargm. Skiagram of the chest was also normal.
A provisional diagnosis of acute cholecystitis was made and the patient was put on nasogastric suction, intravenous fluids, antispasmodics and antibiotics. He showed a drammatic improvement to this conservative treatment and was almost symptom-free after 3 days. He received a vermifuge and was dewormed. He was discharged from the hospital and an oral cholecystogram was taken after a fortnight which revealed a non-functioning gall bladder. The patient was again admitted, for an elective laparotomy. Abdomen was opened by Kocher's incision. Lots of adhesions which were found around the gall bladder, were lysed. Gall bladder was found to be fibrosed having a thick wall. The lymph node of Lund was enlarged. The common bile duct was normal. The liver, spleen and the rest of the viscera were normal. A few worms were found in the small gut here and there. Cholecystectomy was performed by duct first method. On incising the gall bladder, a coiled up dead Ascaris lumbricoides, about 15.5 cm long was found inside its lumen [Fig. 1]. There was no stone present in the gall bladder. The post-operative period was uneventful and the patient was discharged on the 7th post-operative day. He has been regularly attending our follow-up clinics for the last 11/2 years and is symptom free.
Though, infestation of the biliary tract by ascarides has been reported by many authors in the past, ascariasis of the gall bladder is comparatively a rare condition. Ochsner et al[3] believed that it occurred in patients with abnormal papillae of the common bile duct.
Pre-operative diagnosis of ascariasis of gall bladder is rarely made with any great degree of certainty because it is a rare condition and symptoms do not differ in general from those of the common varieties of inflammation and obstruction. As suggested by Butt,[2] cholecystectomy is probably the operation of choice for ascariasis of the gall bladder.
| 1. | Boettiger, C. and Werne, J.: Ascaris lumbricoides found in the cavity of human heart. J. Amer. Med. Assoc., 93: 32, 1929.  |
| 2. | Butt, A. P.: Round worm in gall bladder. Surg. Gynaec. & Obstet., 35: 215-216, 1922. |
| 3. | Ochsner, A., DeBakey, E. G. and Dixon, J. L.: Complications of ascariasis requiring surgical treatment. Report of a case with abdomino-thoracic complications. Amer. J. Dis. Children, 40: 389-407, 1949. |
| 4. | Yang, S. C. H. and Laube, P. J.: Biliary ascariasis; Report of 19 cases. Ann. Surg., 123: 299-303, 1946. |
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