Pancreatic duct ascariasis: clinical presentation, management and outcome.

Background: Infection with ascaris is seen globally. The adult roundworms frequently migrate into the biliary tree from the small intestine. Migration into the pancreatic duct is a rare event due to its narrow caliber and tortuosity. The aim is to present the incidence, clinical features, diagnostic modalities and outcome of pancreatic duct ascariasis. Methods: This is a retrospective cum prospective study over a period of 18 years. During this period 3357 cases of hepatobiliary and pancreatic ascariasis were seen and 51 had pancreatic duct ascariasis. Interpretation: There were 28 females; 10(19.6%) patients were below 18 years of age. The mean age was 38 ± 5.3 years (range 7- 48 years). Three types of pancreatic duct ascariasis were identified. a) Isolated pancreatic duct ascariasis (15 patients); b) concomitant pancreatic and bile duct ascariasis in (27patients); c) worm across ampulla of Vater entering into the pancreatic duct (9 patients). Pancreatitis was mild in 43(84.31%) and severe in 8 patients (15.69%).Ultrasonography is an excellent diagnostic tool. Majority of patients responded to conservative management. Endoscopy was performed in 23 patients with severe pain and in 9 patients’ worms hanging across the ampulla was extracted. Endoscopic retrograde cholangiopancreatography was performed in 11patients with pyogenic cholangitis, severe pancreatitis and worsening cholecystitis. Surgery was done in 2 patients. Patients with concomitant worms in the biliary tree and pancreatic duct had significantly higher incidence of severe pancreatitis (p <0.05), more complications and need for surgery (p <0.05).Mortality was 1.9%. Conclusions: Endoscopic management is useful in patients with complications.