Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2016; 22(33): 7507-7517
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7507
Hepatobiliary and pancreatic ascariasis
Mohammad S Khuroo, Ajaz A Rather, Naira S Khuroo, Mehnaaz S Khuroo
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010, India
Mohammad S Khuroo, Digestive Diseases Centre, Dr. Khuroo’s medical Clinic, Srinagar, Kashmir 190010, India
Ajaz A Rather, Department of Surgery, SKIMS Medical College and Hospital, Bemina, Srinagar, Kashmir 190010, India
Naira S Khuroo, Consultant Radiology, Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Srinagar, Kashmir 190010, India
Mehnaaz S Khuroo, Department of Pathology, Govt. Medical College, Srinagar, Kashmir 190001, India
Author contributions: All authors contributed equally; Rather AA, Khuroo NS and Khuroo MS made literature search; Khuroo NS conducted the radiological studies and critically reviewed the images; Khuroo MS and Khuroo NS wrote the paper; all authors read the paper and made necessary corrections.
Supported by Dr. Khuroo’s Medical Trust, a nonprofit organization which supports academic activities, disseminates medical education and helps poor patients for medical treatment.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mohammad S Khuroo, Director, Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Sector 1, SK Colony, Qamarwari, Srinagar, Kashmir 190010, India.
Telephone: +91-194-2492398 Fax: +91-194-2491190
Received: March 29, 2016
Peer-review started: March 30, 2016
First decision: May 12, 2016
Revised: June 15, 2016
Accepted: July 20, 2016
Article in press: July 21, 2016
Published online: September 7, 2016

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

Keywords: Ascaris lumbricoides, Cholecystitis, Biliary calculi, Cholangitis, Pancreatitis, Recurrent pyogenic cholangitis

Core tip:Ascaris lumbricoides infects more than 1.4 billion people throughout the world. The impact of diseases caused by the parasite had been underestimated. Hepatobiliary and pancreatic ascariasis (HPA) as a clinical entity came in to limelight of late with developments in biliary imaging. Now the disease is recognized as major health problem in endemic regions of the world. However, clinicians all over the world need to be aware of HPA as the disease can be seen in nonendemic areas in migrant population. This article shall focus on the impact of HPA in healthcare in endemic zones and highlight the diagnosis and management options.