Diagnosis and treatment of Ascarial pancreatitis: a case report and literature review.

BACKGROUND

The prevalence of diseases caused by parasites has decreased due to improved sanitary conditions. Acute pancreatitis caused by parasites, especially Ascaris lumbricoides worms, is relatively rare and difficult to diagnose. In some cases, it may even be misdiagnosed as idiopathic acute pancreatitis due to the difficulty of identifying the underlying cause. Research indicates that about 1.4 billion people worldwide are infected with Ascaris lumbricoides worms, and pancreatitis caused by roundworms accounts for only 5.50% of the total cases. Therefore, it is imperative to gain a comprehensive understanding of the pathological process, diagnosis, and treatment of pancreatitis caused by Ascaris lumbricoides worms.

CASE PRESENTATION: We describe a case of Ascariasis-induced pancreatitis in an 82-year-old woman who was admitted to our emergency department with persistent abdominal pain, nausea, and vomiting for 6 h. Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed abnormal tubular signals in the common bile duct segment, accompanied by dilation of the hilar and common bile ducts. Consequently, a diagnosis of Ascariasis-induced pancreatitis was made.

RESULT: Ascariasis-induced pancreatitis was detected in individuals of all age groups and genders. Most cases occurred in Asia (43 cases, 66.15%) and Europe (8 cases, 12.3%). The most common symptoms were abdominal pain and fever. The diagnosis was primarily by ultrasound examination (43.3%) and endoscopic procedures. Regarding treatment, 76.7% of the patients received antiparasitic drugs, while 85.45% underwent endoscopic procedures to directly remove the Ascaris worms. In our case, the patient underwent laparoscopic procedures to remove a 20 cm-long ascaris worms and alleviate symptoms.

CONCLUSION

Ascariasis-induced pancreatitis is more commonly detected among Asians, being more frequent with adult females. The clinical symptoms are often atypical compared to those of pancreatitis caused by other etiologies. In cases of acute pancreatitis resulting from biliary ascariasis, it is recommended that clinicians employ a combination of imaging modalities to support the diagnostic process. The literature indicates that endoscopic retrograde cholangiopancreatography (ERCP) has been the primary treatment approach in the majority of reported cases. In recent years, laparoscopic surgery has been found to be associated with faster recovery and reduced trauma. In complex cases involving severe cholecystitis or intrahepatic biliary ascariasis, laparoscopy offers distinct and irreplaceable benefits.