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Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure.

Chalkoo M, Masoodi I, Hussain S, Chalkoo S, Farooq O - J Minim Access Surg (2009 Jul-Sep)

Bottom Line: We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis.The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure.Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Government Medical College, SMHS and Associated Hospitals, Srinagar, Jammu and Kashmir, State, India.

ABSTRACT
We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

No MeSH data available.


Related in: MedlinePlus

Dead worm being removed from the common bile duct
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Figure 0001: Dead worm being removed from the common bile duct

Mentions: On examination, she was conscious, oriented haemodynamically stable and had icterus. She had no oedema or lymphadenopathy or signs of chronic liver disease. She had a pulse rate of 96 beats per minute and body temperature of 101°F. Her abdominal examination revealed soft hepatomegaly 2 cm below the costal margin in the midclavicular line and no splenomegaly or free fluid. Her other systemic examination was normal. On evaluation, she had leucocytosis (TLC 14,500) with predominant neutrophilia (P82L12). Her liver function test revealed serum bilirubin levels of 6.2 mg/dl and transaminase levels (SGOT and SGPT) of 38 and 42 IU (reference range SGOT/SGPT 22/24). She had marked elevation of serum alkaline phosphatase of 62 KA units (reference range of ALP 11-13 KA units). Her kidney function tests and electrolytes were normal. Her ultrasound revealed an echogenic linear shadow in the common bile duct (CBD) and a grossly dilated intrahepatic biliary ductal system. Her blood cultures were sterile. Her cholangitis wasmanaged with IV fluids and antibiotics, and she was subjected to endoscopic retrograde cholangiopancreatography (ERCP). Despite the multiple attempts made, worm could not be extracted from the CBD. There was some technical problem and we could not visualize the worm through ERCP. She was later taken up for laparoscopic CBD exploration. On laparoscopic examination, the CBD was grossly dilated and a dead worm was removed from CBD [Figures 1 and 2]. We used suction and irrigation in an alternate mode for the removal of the dead worm [Figure 3]. T-tube was placed in situ. In the postoperative period, the T-tube was managed the same way as in conventional open choledochotomy. We tried intermittent clamping of the tube from 8th P.O.D and we did not observe abdominal pain or jaundice and on 12th P.O.D a T-tube cholangiogram was done which did not show any filling defects in the CBD. The T-tube was removed uneventfully. She had marked relief in her symptoms and became afebrile. Her bilrubin and serum ALP levels had a progressive fall and she was discharged after 3 days from the hospital afebrile without any complication. She was dewormed and is following our OPD.


Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure.

Chalkoo M, Masoodi I, Hussain S, Chalkoo S, Farooq O - J Minim Access Surg (2009 Jul-Sep)

Dead worm being removed from the common bile duct
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822177&req=5

Figure 0001: Dead worm being removed from the common bile duct
Mentions: On examination, she was conscious, oriented haemodynamically stable and had icterus. She had no oedema or lymphadenopathy or signs of chronic liver disease. She had a pulse rate of 96 beats per minute and body temperature of 101°F. Her abdominal examination revealed soft hepatomegaly 2 cm below the costal margin in the midclavicular line and no splenomegaly or free fluid. Her other systemic examination was normal. On evaluation, she had leucocytosis (TLC 14,500) with predominant neutrophilia (P82L12). Her liver function test revealed serum bilirubin levels of 6.2 mg/dl and transaminase levels (SGOT and SGPT) of 38 and 42 IU (reference range SGOT/SGPT 22/24). She had marked elevation of serum alkaline phosphatase of 62 KA units (reference range of ALP 11-13 KA units). Her kidney function tests and electrolytes were normal. Her ultrasound revealed an echogenic linear shadow in the common bile duct (CBD) and a grossly dilated intrahepatic biliary ductal system. Her blood cultures were sterile. Her cholangitis wasmanaged with IV fluids and antibiotics, and she was subjected to endoscopic retrograde cholangiopancreatography (ERCP). Despite the multiple attempts made, worm could not be extracted from the CBD. There was some technical problem and we could not visualize the worm through ERCP. She was later taken up for laparoscopic CBD exploration. On laparoscopic examination, the CBD was grossly dilated and a dead worm was removed from CBD [Figures 1 and 2]. We used suction and irrigation in an alternate mode for the removal of the dead worm [Figure 3]. T-tube was placed in situ. In the postoperative period, the T-tube was managed the same way as in conventional open choledochotomy. We tried intermittent clamping of the tube from 8th P.O.D and we did not observe abdominal pain or jaundice and on 12th P.O.D a T-tube cholangiogram was done which did not show any filling defects in the CBD. The T-tube was removed uneventfully. She had marked relief in her symptoms and became afebrile. Her bilrubin and serum ALP levels had a progressive fall and she was discharged after 3 days from the hospital afebrile without any complication. She was dewormed and is following our OPD.

Bottom Line: We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis.The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure.Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Government Medical College, SMHS and Associated Hospitals, Srinagar, Jammu and Kashmir, State, India.

ABSTRACT
We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.

No MeSH data available.


Related in: MedlinePlus