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home - Biliary - Biliary Parasites - Ascaris and Echinococcus Written by Dr Sebastian Zeki

Ascaris and Echinococcus

Written by Dr Sebastian Zeki sphincter of Oddi stenosis and sclerosing cholangitis (usually if formalin used). Late complications: Early complications: Preoperative ERCPFor sphincterotomy+removal of cysts with basket/ flushingSurgery: Inject cysticidal agent eg ethanol/ iodophor), 30 mins pre-excision unless communicating with biliary tree. Role of ERCP — Transmission external fistula- treat with biliary drain. Host is dogs, wolves and fox intestines. Ascaris Lumbricoides (Roundworm) Oral ingestion Eggs in faeces 3 intraductal patterns: -Filliform, linear, wavy material in the CBD (=laminated hydatid membranes or ill-defined, irregular leaf-like filling defects due to fragmented membranes)-Round or oval lucent filling defects, floating in the CBD (=daughter cysts)-Brown, thick, amorphous debris. Treatment:Antihelminthic therapy (Albendazole).Surgical resection of the cyst.Percutaneous aspiration and instillation of scolicidal agents.ERCP for pre/post op complications. The parasite forms a hydatid cyst in humans and other species, which serve as intermedi-ate hosts.The most common site of cystic hydatid disease is the liver Linear low intensity filling defect in the bile ducts. USS Findings: -Long worm like echo-genic structures.-"Four lines sign" — Echogenic strips with an anechoic central tube (the worms’ digestive system) . MRCP USS Often seen crossing the ampulla at ERCPEndoscopic extraction of adult worms:a) If protruding out of papilla, use grasping forceps and pull worm and scope out.b) If in duct, will sometimes come out after contrast injected, or extract with a basket or occlusion balloon.c) Dont snare it, as it will cut the wormd) Dont do sphincterotomy as it allows the worms further access (but can use papillary balloon dilatation)-A single oral dose of albendazole / mebendazole will usually Duodenum Jejunum Echinococcus Granulosus-Clinical Presentation75% are asymptomatic. 25% rupture into biliary tree/ peritoneum with dilatation and cholangitis (daughter cysts and scolices causing blockage).Radiology-shows cysts +/- biliary tree dilatation.Cholangiography- shows minor communications, esp. with peripheral ducts.99mTc–labeled albumin aggregate injection: into cysts can assist in detection of leakage into systemic circulation.OGD can show whitish, glistening membranes lying in the duodenum, or impacted in the papilla of vater. Reside in the jejunum Actively motile and can enter the CBD causing biliary obstruction or pancreatitis

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