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Abdomen » Liver & Biliary System
Ascaris in Gallbladder
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Presentation 18 year old female patient with severe illness, high fever, pain in right hypochondrium, extending to the rest of the abdomen.

 
 
 
Caption: Sagittal through gallbladder
Description: A complex tubular structure is seen within the gallbladder. Multiple small gallstones are present.
 
 
 
Caption: Sagittal gallbladder
Description: A slightly different plane again demonstrates the curving tubular structure and multiple small faceted gallstones dependent in the neck of the gallbladder.
 
 
Caption: Realtime sagittal gallbladder
Description: The tubular structures represent Ascaris worms which are actively mobile within the gallbladder. Also noted are multiple small gallbladder stones.
 
 
Caption: Realtime sagittal gallbladder
Description: A slightly different scan plane again demonstrates the actively mobile worms and the dependent gallstones. Also noted is a slightly thickened and irregular appearing gallbladder wall.
 
 
Caption: Realtime sagittal gallbladder
Description: 
 
Differential Diagnosis Ascaris in gallbladder
Cholecystitis
Cholelithiasis
 
Final Diagnosis Ascaris in gallbladder
Cholecystitis with cholelithiasis
 
Discussion The echogenic tubular structures within the gallbladder lumen can be seen to actively move on the video clips, suggesting the presence of Ascaris Lumbricoides worms that have migrated into the biliary system.  The largest of the nematodes found in humans, Ascaris Lumbricoides infections are common in areas of poor sanitation and has been estimated to affect as much as 20% of the world's population.  However, infestation of the gallbladder is relatively rare.  This case illustrates well-demonstrated actively mobile worms in the gallbladder, accompanied by multiple small gallstones and coarse sludge.
 
Case References Ascaris Lumbricoides.  eMedicine Emergency Medicine.  Aaron Dora-Laskey, MD ; Ugo Anthony Ezenkwele, MD, MPH; ric L Weiss, MD, DTM&H. http://emedicine.medscape.com/article/788398-overview

N.    B.    Topal, H.    Özgüc, S.    Kilicturgay, S.    Orcan &    P.    Tasar    : Gallbladder Ascariasis: Radiological Evaluation and Successful Elimination by Medical Treatment after Migration to the Intestine . The Internet Journal of Gastroenterology. 2007   Volume 5 Number 2.  http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijge/vol5n2/ascaris.xml

 
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