ascaris in gallbladder

Ultrasonography is an important noninvasive diagnostic procedure in the evaluation of these patients, who usually present with a clinical picture suggesting gallstone disease ( 7 ). Ultrasonographic appearance of biliary ascariasis is well documented. The worm is usually seen as a long, linear or curved, nonshadowing echogenic strip containing a central, longitudinal anechoic tube, probably representing the digestive tract ( 2 , 4 , 7 , 8 , 9 ). Movement of worm in the biliary tree is characteristic and is confirmatory evidence in ultrasonographic diagnosis ( 2 ).

Gallbladder ascariasis responds poorly to medical treatment because less than 1% of the antiparasitic drugs are excreted in bile ( 4 ). Therefore, patients are usually treated by endoscopy or surgery. Javid et al reported that only ten of 47 patients expelled the worm spontaneously, while 37 required surgical treatment. After the worms migrate out of biliary tree into the duodenum, the antiparasitic drugs can act upon them ( 3 ). In our case we administered albendazole and after the worm disappeared from the biliary tree we found dead Ascaris bodies in the feces. US readily show the movement of the worm in the biliary tree and this is an advantage of US over CT and MRI ( 6 ).

In conclusion, US provides a simple, rapid approach for the diagnosis and follow-up of patients with Ascariasis and other imaging modalities such as MRI are rarely needed. On the other hand, in some patients, gallbladder Ascariasis can be treated by medical treatment. Therefore according to us, the medical treatment sholud be the initial choise before surgery



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