CASE REPORT
A 58 yea s old male consul ed o his p ac i ione due o long e olu ion and con inuous abdominal pain wi h non cons an
dia hea. His medical his o y includes ch onic ischemic ca diopa hy, a ial lu e , hype ension, bila e al hip p os hesis. A
colonoscopy was pe o med inding no abno mali ies. The scanne showed an in il a i e mesen e ic mass o 7 x 14 cm
wi h unde ined ma gins which con ac ed wi h panc ea ic cephalic po ion and uncina e p ocess (Fig. 1). A MRI dismissed
local and lin o ascula in il a ion. The s udy was comple ed wi h a FNA cy ology guided by EUS being posi i e o neoplas ic
cells, sugges ing panc ea ic adenoca cinoma mode a ely di e en ia ed. A e his diagnosis cephalic panc ea icoduodenec omy
was pe o med.
Pos ope a i e e olu ion was good wi h a panc ea ic leak sol ed wi h medical measu es. Fu he ana omical pa hology
analysis demons a ed panc ea ic asca iasis wi h ib ocaseous nodules and abscess a ec ing cephalic panc eas and ans e se
mesocolon (Fig. 2). The e we e no umo cells ounded in he su gical specimen. The pa ien was ea ed wi h albendazole
400 mg.
DISCUSSION
Asca iasis is equen helmin hic in ec ion which is su e ed by a qua e o he human popula ion. I s condi ion is endemic
in de eloping coun ies, Asia and La in Ame ica. In de eloped coun ies i is unusual (1). The biliopanc ea ic a ec ion is
unlikely, being in ou en i onmen ex emely a e, bu i can be esponsible o po en ially se ious complica ions (2).
Thei eggs (Fig. 3) a e swallowed, he la ae eme ge, hey in ade in es inal mucosa and ge h ough he po al and sys emic
ci cula ion o lungs whe e hey ma u a e and mo e o pha ynx
ge ing he diges i e ac again. They colonize he small in es ine
and hey emain causing no symp oms in mos o cases (1,2).
Inbe ween abdominal mani es a ions we ocus on bil-
iopanc ea ic sphe e. Toxins exc e ed by he nema odes (neu-
o oxins, ana ilo oxins, hemolysins,...) p oduce a spam a
Oddi’s sphinc e (3), and plus de i us om he in es inal
ac , bile and panc eas canalicules may ge occluded and
in ec o ganic luids (2). The mos common o m is he bil-
ia y colic. Less equen bu mo e anscenden al a e o he
condi ions such as acu e cholecys ic, cholangi is, li e
abscess, obs uc i e jaundice, choledocoli hiasis and acu e
and ch onic panc ea i is (4,5).
The elec i e me hod o diagnosis is mic oscopic iden i i-
ca ion o he eggs in he eces, he esh exam is able o de ec
mode a e o high in ec ions. The US may be diagnos ic in
case wo ms a e di ec ly seen.
The ea men o bilia y asca iasis is bases in diges i e
epose, analgesia, ex ended spec um an ibio he apy (i he e
Asca is lumb icoides as e iologic ac o o panc eas
in lamma o y umo
Ma ía Dolo es Casado-Maes e, José Ma ía Álamo-Ma ínez, Juan José Segu a-Sanped o,
Elena Du án-Izquie do, Luis Miguel Ma ín-Gómez, Ca men Be nal-Bellido, Gonzalo Suá ez-A acho,
Juan Se ano-Díez-Canedo, Miguel Ángel Gómez-B a o and F ancisco Ja ie Padillo-Ruiz
Uni o Hepa obiliopanc ea ic and T ansplan Su ge y, Depa men o Gene al Su ge y and Diges i e Diseases.
Hospi ales Uni e si a ios Vi gen del Rocío. Se illa, Spain
1130-0108/2011/103/11/592-593
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
Copy igh © 2011 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Mad id)
Vol. 103. N.° 11, pp. 592-593, 2011
PICTURES IN DIGESTIVE PATHOLOGY
Fig. 1. In lamma o y p ocess o e panc eas cephalic po ion.
08_IPD_2181-Casado.ing_Maque ación 1 18/11/11 13:31 Página 592
is in a-abdominal in ec ion) and o e adica e he wo ms using albendazole, py an el pamoa e, mebendazole o le amisole
(1). The ex ac ion o wo ms using ERCP is a alid op ion in bile and panc eas obs uc ions (6).
Al hough i is excep ional in ou en i onmen , Asca is lumb icoides should be pa o di e en ial diagnosis o cephalic
panc eas in lamma o y umo s.
REFERENCES
1. Khu oo MS. Asca iasis. Gas oen e ol Clin No h Am 1996;25:553-77.
2. Khu oo MS, Za ga SA, Mahajan R. Hepa obilia y and panc ea ic asca iasis in India. Lance . 1990;335(8704):1503-6
3. Alam S, Mus a a G, Rahman S, Kabi SA, Rashid HO, Khan M. Compa a i e s udy on p esen a ion o bilia y asca iasis wi h dead and li ing wo ms. Saudi
J Gas oen e ol 2010;16:203-6.
4. Ta a de MR, Ca abin H, Joseph L, Balolong E J , Ol eda R, McGa ey ST. Es ima ing he sensi i i y and speci ici y o Ka o-Ka z s ool examina ion
echnique o de ec ion o hookwo ms, Asca is lumb icoides and T ichu is ichiu a in ec ions in humans in he absence o a ‘gold s anda d’. In J Pa asi ol
2010;40(4):399-404.
5. Ochoa B. Su gical complica ions o asca iasis. Wo ld J Su g 1991;15:222-7.
6. Mangia illano B, Ca a a S, Pe one MC, A cidiacono PG, Tes oni PA. Asca is lumb icoides-induced acu e panc ea i is: diagnosis du ing EUS o a
suspec ed small panc ea ic umo . JO. 2009;10(5):570-2.
Vol. 103. N.° 11, 2011 ASCARIS LUMBRICOIDES AS ETIOLOGIC FACTOR FOR PANCREAS INFLAMMATORY TUMOR 593
REV ESP ENFERM DIG 2011; 103 (11): 592-593
Fig. 2. In a low augmen (4x), we obse e all o e he image o al s uc u es
wi h a plain double laye and some o hem wi h lumpy ma e ial inside.
This image co esponds o ans e sal and longi udinal cu s o Asca is
lumb icoides.
Fig. 3. In a high augmen (40x), we can app ecia e he double laye , i e-
gula s wi h mamelons, less isible ex e nally, wi h g anula emaining in
he inside (Asca is emb yona ed s uc u es). In e ile o emb yona ed
egg.
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