Copyright ©The Author(s) 2016.
World J Gastroenterol. Sep 7, 2016; 22(33): 7507-7517
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7507
Table 1 Clinical syndromes related to ascariasis in endemic areas
Disease classificationPathogenesisClinical syndromes
Ascaris pneumoniaLarval migration in lungsSelf-limiting pneumonia
Status asthmaticus needing ICU admission
Intestinal ascariasisAscarides aggregation in small bowel lumenIntestinal obstruction, bowel infarction and gangrene
Appendicular ascariasisAscaris blocking appendix orificeAppendicular colic, appendicitis, appendicular gangrene
Peritoneal ascariasisAscaride-related gut perforationPeritonitis, septic shock
Gastric ascariasisAscarides in stomach and esophagusPyloric 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 ascariasisDuodenal ascariasis invading ampullary orificeBiliary 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 malnutritionHigh ascaride load in children-
Table 2 Ultrasonography findings of hepatobiliary and pancreatic ascariasis
Site of ascaridesUltrasonography findings
Stomach and duodenumLong linear or curved echogenic strips without acoustic shadowing within water filled duodenum and stomach. The structures show active motility
Hepatobiliary ascariasisSingle or multiple long linear or curved echogenic structures without acoustic shadowing
Thick long linear or curve non-shadowing echogenic strip containing a central longitudinal anechoic tube (four-line sign), representing the digestive tract of the worm
Characteristic writhing movement of the echogenic strips within the ducts
Gall bladder and cystic duct distension; gall bladder wall edema; sludge within gall bladder
Multiple liver abscesses
Gall bladder ascariasisLong coiled echogenic structure within gall bladder lumen
Tubular echogenic structures within gall bladder lumen
Echogenic structures exhibiting rapid movements
Distended gall bladder, gall bladder wall edema
Pancreatic ascariasisLong linear nonshadowing echogenic strips within a dilated pancreatic duct
Edematous pancreas