In that wormy world: Watch the dance of the biliary demon. Worm extraction from bile ducts. скачать в хорошем качестве

In that wormy world: Watch the dance of the biliary demon. Worm extraction from bile ducts.

In that wormy world: Watch the dance of the biliary demon. Worm extraction from bile ducts. Dear viewers Ascariasis infects 25% of the world's population; however, most ascaris infections are without clinical disease. Even then, it causes clinical disease in 1.2 to 2 million cases with 20,000 deaths per year. The clinical manifestations are primarily related to the worm's peculiar movement in the gut lumen and its ability to explore and enter various body orifices. One of the favourite orifices the worm explores and enters is the ampullary orifice situated in the second part of the duodenum, causing the clinical disease Hepatobiliary and pancreatic ascariasis. Kashmir Valley is a highly endemic zone for ascariasis, and hepatobiliary and pancreatic diseases caused by the worm are a significant health problem in the community. Here we depict the video images of a 30-year-old woman who had a worm in the bile duct with significant biliary pain and cholangitis and needed worm extraction from the bile duct at ERCP. The video shows a peculiar dance of the worm in the duodenum. With these dancing movements, the worm explores and enters the ampullary orifice situated in the second part of the duodenum. Ultrasound is a reliable tool for diagnosing worms in the bile ducts. In the longitudinal view, worms appear as long echogenic strips with a central anechoic tube, representing the worm's alimentary canal. In the transverse view, worms look like echogenic discs with an anechoic center. An ERCP was done in this patient because of severe intractable biliary pain and severe cholangitis. The cholangiogram revealed a long linear filling defect in the bile duct, which was caused by the worm in the duct. At ERCP, we aimed to extract the worm from the bile duct. An endoscopic basket was introduced through the ampullary orifice into the bile duct. The worm was caught with the basket and removed from the bile duct. The 25 cm long and 6 mm thick worm extracted from the bile duct is shown. Following the worm extraction, we performed a repeat cholangiogram, which showed no filling defect, suggesting that the worm had been successfully extracted from the bile ducts. Following worm extraction, the patient had rapid relief of biliary pain and resolution of cholangitis. Worm extraction during ERCP represents a significant therapeutic advance in the treatment of hepatobiliary and pancreatic ascariasis, and is essential in a subgroup of patients with intractable pain, severe cholangitis, and acute pancreatitis. 1. Hepatobiliary and Pancreatic Ascariasis in India: Khuroo, M.S. et al. The Lancet, Volume 335, Issue 8704, 1503 – 1506 2. Worm extraction and biliary drainage in hepatobiliary and pancreatic ascariasis. Khuroo, M.S. et al. Gastrointest Endosc. 1993 Sep-Oct;39(5):680-5.