Hepatobiliary and pancreatic ascariasis

Table 1 Clinical syndromes related to ascariasis in endemic areas

Disease classification	Pathogenesis	Clinical syndromes
Ascaris pneumonia	Larval migration in lungs	Self-limiting pneumonia
		Status asthmaticus needing ICU admission
Intestinal ascariasis	Ascarides aggregation in small bowel lumen	Intestinal obstruction, bowel infarction and gangrene
Appendicular ascariasis	Ascaris blocking appendix orifice	Appendicular colic, appendicitis, appendicular gangrene
Peritoneal ascariasis	Ascaride-related gut perforation	Peritonitis, septic shock
Gastric ascariasis	Ascarides in stomach and esophagus	Pyloric obstruction (ascaris in antrum and blocking pylorus)
		Nocturnal chocking (ascaris traversing in to gullet at night)
		Unique retrosternal itching (ascarides in fundus and lower esophagus)
Hepatobiliary and pancreatic ascariasis	Duodenal ascariasis invading ampullary orifice	Biliary colic (duodenal ascariasis)
		Acute cholangitis (hepatic ascariasis; massive worm load can cause septic cholangitis and shock)
		Acalculous cholecystitis (choledochal or gall bladder ascariasis; ascarides in gall bladder may cause gall bladder gangrene)
		Hepatic abscess (hepatic ascariasis)
		Acute pancreatitis (duodenal ascariasis or pancreatic ascariasis, ascaride in pancreatic duct can cause necrotizing pancreatitis)
		Hepatolithiasis (dead ascarides in hepatic ducts forming nidus of sludge/stones)
Stunting of growth, cognitive dysfunction and malnutrition	High ascaride load in children	-