1/4. Right hepatic segmentectomy for the treatment of intrahepatic biliary stones due to ascaris lumbricoides: report of a case. We report herein the case of a 46-year-old woman investigated for recurrent acute cholangitis. Ultrasound, endoscopic retrograde cholangiopancreatography, and computed tomography scan revealed dilatation and multiple images suggestive of intrahepatic biliary stones in the ducts that drained segments V and VI of the liver. Endoscopic treatment was attempted unsuccessfully, and based on the severity of the last crisis of cholangitis a laparotomy was performed. A right hepatic lobectomy including segments V and VI was carried out without any complications, resulting in complete relief of symptoms. Pathological examination of the liver demonstrated the presence of worm nests in the liver parenchyma with chronic granulomatous lesions. ( info) |
2/4. The sixth case of lagochilascariasis minor in Surinam. The sixth case of lagochilascariasis minor in Surinam is reported in a 13-year-old boy. He had abscesses on the right and left side of the neck, with fistulae out of which eggs, larvae and adult worms were expelled. Treatment with thiabendazole and levamisole were ineffective. Finally he was cured after prolonged treatment with albendazole. This is probably the 63rd case of lagochilascariasis minor in the world, but there is a possibility that infection with this rare nematode is underreported. ( info) |
| adult Ascaris, which are usually found in the intestine, can enter the ampulla of vater if the sphincter of oddi is not efficient. This situation seems common in children; in adults it occurs after endoscopic or surgical sphincterotomy. The worms can then migrate up into the intrahepatic bile ducts and provoke biliary stasis which may become infected and complicated by abscesses. It is inside such abscesses that we may find fragments of adult Ascaris. In the 4 cases reported in the literature during the last 20 years, we note in particular that the clinical signs vary considerably, according to the age of the patient. In children, the parasitic infestation is often massive and the clinical features are extremely serious, namely shock and acute abdominal pain, which lead to a laparotomy being done. In adults, the clinical feature is that of a biliary infection. Here we describe a fifth case of hepatic ascaridiasis which differs from the others in that the diagnosis was established by ERCP and CT scan and that treatment was medical. ( info) |
4/4. Human lagochilascariasis treated successfully with ivermectin: a case report. A 15 year old male patient was diagnosed as being infected with the nematode Lagochilascaris minor, presenting as abscesses over the left mastoid region, and invading the temporal bone, mastoid sinuses and possibly the CNS. Surgical drainage and administration of cambendazole and levamisole led to improvement, followed by an early relapse and poor tolerance to the antihelminthic drugs. Repeated doses of ivermectin (an animal preparation) were used for the first time to treat this condition and resulted in complete remission of signs of infection, maintained for 15 months after the end of drug therapy, indicating cure of the disease. ( info) |