Ascariasis in the Hepatobiliary System: Laparoscopic Management
| Autor: | Bolívar Serrano, J. Andres Astudillo, Emanuel Sporn, Rubén Astudillo |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Liver Diseases Parasitic Biliary Tract Diseases medicine.medical_treatment Ascariasis medicine Humans Laparoscopy Aged Retrospective Studies medicine.diagnostic_test Common bile duct business.industry Middle Aged medicine.disease Endoscopy Surgery Treatment Outcome medicine.anatomical_structure Cystic duct Female Cholecystectomy Differential diagnosis business Algorithms Liver abscess |
| Zdroj: | Journal of the American College of Surgeons. 207:527-532 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2008.05.020 |
| Popis: | Background Ascariasis is an endemic disease in developing countries. The parasite can invade the hepatobiliary tree and cause symptoms. Medical therapy can be ineffective in these patients and intervention techniques required. Study Design A retrospective review of patient charts between February 1992 and February 2007 in the Hospital Latinoamericano, Cuenca, Ecuador, was performed to identify patients having surgical or endoscopic treatment for hepatobiliary ascariasis. Patient demographics, treatment algorithms, and outcomes are described and analyzed. Results There were 13 cases of hepatobiliary infestation by ascaris treated through endoscopy or operation. All patients presented with colicky abdominal pain in the right upper quadrant. Hepatic and biliary ultrasonography identified parasites in 12 patients. In the other patient, a hepatic abscess containing ascaris was found incidentally during cholecystectomy. There were 11 patients with ascariasis in the common bile duct, 1 in whom the cystic duct was occluded, causing acute cholecystitis. In 12 patients, conservative management was attempted and was unsuccessful. Endoscopic extraction was successful in four of these patients. Six patients underwent laparoscopic cholecystectomy, common bile duct exploration with parasite extraction, and T-tube placement. Parasite extraction through common bile duct exploration followed by primary closure was performed in one patient. Cholecystotomy and parasite extraction followed by cholecystectomy were performed in one patient. The final patient had cholecystectomy and parasite extraction from a liver abscess without earlier medical therapy. Conclusions Ascariasis in the hepatobiliary system should be considered in the differential diagnosis of upper abdominal pain for patients in populations at risk. When an operation is indicated, it can be accomplished by endoscopic or laparoscopic approach. |
| Databáze: | OpenAIRE |
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