Management of Biliary Ascariasis in Pregnancy

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2005 Sep 6

PMID 16142431

Citations 7

Authors

Omar Javed Shah

Irfan Robanni

Fayaz Khan

Showkat Ali Zargar

Gul Javid

Affiliations

Soon will be listed here.

Abstract

Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. Biliary ascariasis is one of the most common and well described entities caused by ascaris. In endemic areas pregnant women are prone to develop biliary ascariasis. Its management poses a great challenge to both the attending surgeon and the endoscopist. Between January 1993 and March 2003, 15 cases of biliary ascariasis were seen in pregnant patients in our institution. Ultrasonography was used as the main investigative tool. Treatment involved management by conservative, endoscopic, and surgical methods, taking due care of both the mother and the fetus. Ten patients (66.6%) were in the third trimester of pregnancy, and 10 (66.6%) patients were in their third pregnancy. Ultrasonography proved to be the best tool for diagnosing and monitoring worms inside the biliary ductal system. Nine (60%) patients responded to the conservative treatment; endoscopic extraction was successful in 4 (66.6%) patients. Surgical treatment was required in 2 (13.3%) patients. One (6.6%) patient had had spontaneous abortion at 12 weeks gestation, and one (6.6%) patient had a premature labor. The remaining patients had normal pregnancies. Management of biliary ascariasis in pregnancy is a challenge for both the attending surgeon and the endoscopist. Safe and effective management requires special attention to the gestational age and accurate recognition of the specific pathology in the patient. The majority of patients respond to conservative treatment, but endoscopic extraction may be needed in nonresponsive cases. Lead shielding of the fetus and limitation of the total fluoroscopic exposure during therapeutic endoscopy can minimize the teratogenic risk of ionizing radiation. Failures of endoscopic extraction may lead to surgical intervention, which carries risks of fetal wastage and premature labor. Routine worming of women in the child-bearing years is recommended in endemic areas of ascariasis. Though ascariasis is a problem in developing countries, because of increased travel and population migration, clinicians elsewhere should be aware of the problems associated with ascariasis.

Citing Articles

Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border: Results from a retrospective cohort.

Brummaier T, Tun N, Min A, Gilder M, Archasuksan L, Proux S PLoS Negl Trop Dis. 2021; 15(3):e0009219.

PMID: 33647061 PMC: 7951971. DOI: 10.1371/journal.pntd.0009219.

Gallbladder Perforation Due to in a Pregnant Woman and 6 Year Old Girl from Afghanistan: Case Report.

Mosawi S, Dalimi A, Charkhi M, Baarae O, Darman A, Mosavi M Iran J Parasitol. 2019; 14(3):477-481.

PMID: 31673268 PMC: 6815860.

Hepatobiliary and pancreatic ascariasis.

Khuroo M, Rather A, Khuroo N, Khuroo M World J Gastroenterol. 2016; 22(33):7507-17.

PMID: 27672273 PMC: 5011666. DOI: 10.3748/wjg.v22.i33.7507.

Risks versus benefits of gastrointestinal endoscopy during pregnancy.

Cappell M Nat Rev Gastroenterol Hepatol. 2011; 8(11):610-34.

PMID: 21970872 DOI: 10.1038/nrgastro.2011.162.

Comparative study on presentation of biliary ascariasis with dead and living worms.

Alam S, Mustafa G, Rahman S, Kabir S, Rashid H, Khan M Saudi J Gastroenterol. 2010; 16(3):203-6.

PMID: 20616417 PMC: 3003205. DOI: 10.4103/1319-3767.65200.

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