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Abdomen » Pancreas
Acute pancreatitis of parasitic etiology due to Ascaris lumbricoides
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Presentation 18 years old female with abrupt onset of intense epigastric pain in morning, continuing throughout day.  On admission to emergency service ultrasound of the abdomen was immediately ordered.
 
 
 
Caption: Transverse mid upper abdomen
Description: The pancreas is enlarged, most prominently in the body and tail regions. The distal portion of the pancreatic duct appears highly echogenic.
 
 
Caption: Real time scan of pancreas
Description: In this short video clip you can appreciate the swollen appearance of the pancreas and the characteristic echo pattern of the parasite in the pancreatic duct.
 
Final Diagnosis Acute edematous pancreatitis of parasitic etiology due to Ascaris lumbricoides lodged in the pancreatic duct.
 
Discussion Ultrasound Findings
Enlarged, inflamed appearing pancreas.  In the body of the pancreas there is an echogenic structure corresponding to the pancreatic duct. Free fluid was seen in the pouch of Morrison and in the paracolic gutters, thought to be exudate from the inflamed pancreas.

Lab results for amylase and lipase were consistent with acute pancreatitis
 
Follow Up Diagnosis was confirmed by CT.
The patient was treated for the pancreatitis and with piperazine for the parasite.
Response was very good. 
 
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