Abdominal Ascariasis: Where to Focus on Imaging Studies


USG Ultrasonography
ERCP Endoscopic Retrograde Cholangiopancreatography
ALP Alkaline Phosphatase
CBD Common Bile Duct

How to Cite

Suhail, J., Shah, O., Shah, O., Sarfaraz, J., & Mohuiddin, I. (2020). Abdominal Ascariasis: Where to Focus on Imaging Studies. Galician Medical Journal, 27(3), E202035. https://doi.org/10.21802/gmj.2020.3.5


Objective: To assess the various presentations of abdominal ascariasis and their imaging features for developing a comprehensive radiological evaluation protocol.

Methods: Demographic and clinical profile of 84 patients with abdominal ascariasis was noted. Patients were divided into 2 groups with age less than 20 comprising Group A and those with age greater than 20 Group B. All the patients had a routine lab workup and a dedicated USG scan to look for objective evidence of intestinal or hepatobiliary ascariasis. Any history of previous intervention (cholecystectomy or ERCP) was also sought.

Results: Abdominal ascariasis is more common in females observed in 62% of our patients. Peripheral eosinophilia was observed in 70 (83%) patients. We had 74 (88%) patients with intestinal ascariasis with 2 patients having appendicular ascariasis. Biliary ascariasis was observed in 20 (24%) patients and pancreatic ductal ascariasis in 6 (7%) patients. We found peritoneal ascariasis in 1 (2%) pediatric patient and 2 (3%) patients in our study had ascariasis associated with the liver abscess. OCH was observed in 4 patients while 2 patients presented with worm cholecystitis.

Conclusion: Peripheral eosinophilia can be used to select patients in endemic regions for undergoing a dedicated USG scan. USG is the investigation of choice for both intestinal and hepatobiliary ascariasis. Worm migration is more common in adults and is especially prevalent in individuals with previous history of ERCP or cholecystectomy.



Gutierrez Y. Ascaridida - Ascaris, Lagochilascaris, Anisakis, Pseudoterranova and Baylisascaris. In: Gutierrez Y, editor. Diagnostic Pathology of Parasitic Infections with Clinical Correlations. Philadelphia: Lea & Febiger; 1990. p. 236-247.

Bundy DA, Cooper ES, Thompson DE, Anderson RM, Didier JM. Age-related prevalence and intensity of Trichuris trichiura infection in a St. Lucian community. Trans R Soc Trop Med Hyg. 1987; 81: 85-94. DOI: https://doi.org/10.1016/0035-9203(87)90293-8

Stephenson LS, Latham MC, Kinoti SN, Kurz KM, Brigham H. Improvements in physical fitness of Kenyan schoolboys infected with hookworm, Trichuris trichiura and Ascaris lumbricoides following a single dose of albendazole. Trans R Soc Trop Med Hyg. 1990; 84: 277-282. DOI: https://doi.org/10.1016/0035-9203(90)90286-N

Nokes C, Bundy DA. Does helminth infection affect mental processing and educational achievement? Parasitol Today. 1994; 10: 14-18. DOI: https://doi.org/10.1016/0169-4758(94)90348-4

de Silva NR, Chan MS, Bundy DA. Morbidity and mortality due to ascariasis: Re-estimation and sensitivity analysis of global numbers at risk. Trop Med Int Health. 1997; 2: 519-528. DOI: https://doi.org/10.1046/j.1365-3156.1997.d01-320.x [PMid:9236818]

Langewar DN, Maheshwari MB, Wegholikar UL. Hepatic perforation due to ascariasis. Indian J Pediatr. 1993; 60: 457-459. DOI: https://doi.org/10.1007/BF02751215 [PMid:8253499]

Hoffmann H, Kawooya M, Esterre P, Ravaoalimalala VE, Roth J, Thomas AK, et al. In vivo and in vitro studies on the sonographical detection of Ascaris lumbricoides. Pediatr Radiol [Internet]. 1997 Mar 19;27(3):226–9. DOI: https://doi.org/10.1007/s002470050106 [PMid:9126575]

Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990; 335: 1503-1506. DOI: https://doi.org/10.1016/0140-6736(90)93037-P

Mani S, Merchant H, Sachdev R, Rananavare R, Cunha N. Sonographic evaluation of biliary ascariasis. Australas Radiol. 1997; 41: 204-206. DOI: https://doi.org/10.1111/j.1440-1673.1997.tb00718.x [PMid:9153828]

Louw JH. Biliaray ascariasis in childhood. S Afr J Surg 1974; 12: 19-25.

Pawlowski ZS. Ascariasis. In: Warran KS, Mahmoud AA, editors. Tropical and Geographical Medicine. 2nd ed. New York: McGraw-Hill; 1990. p. 369.

Sun T. Ascariasis. In: Sun T, editor. Pathology and Clinical Features of Parasitic Diseases. New York: Masson; 1980. p. 115-120.

Gutierrez Y. Ascaridida - Ascaris, Lagochilascaris, Anisakis, Pseudoterranova and Baylisascaris. In: Gutierrez Y, editor. Diagnostic Pathology of Parasitic Infections with Clinical Correlations. Philadelphia: Lea & Febiger; 1990. p. 236-247.

Pinus J. Surgical complications of ascariasis. Prog Pediatr Surg. 1982; 15: 79-86.

Lim JH. Oriental cholangiohepatitis: Pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 1991; 157: 1-8. DOI: https://doi.org/10.2214/ajr.157.1.2048504 [PMid:2048504]

Sperling RM, Koch J, Sandhu JS, Cello JP. Recurrent pyogenic cholangitis in Asian immigrants to the United States: Natural history and role of therapeutic ERCP. Dig Dis Sci. 1997; 42: 865-871.

Shah OJ, Zargar SA, Robbani I. Biliary Ascariasis: A Review. World J Surg [Internet]. 2006 Aug 10;30(8):1500–6. DOI: https://doi.org/10.1007/s00268-005-0309-1 [PMid:16874446]

Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreaticbiliary ascariasis: Experience of 300 cases. Am J Gastroenterol. 1997; 92: 2264-2267.

1. Mukhopadhyay M. Biliary ascariasis in the Indian subcontinent: A study of 42 cases. Saudi J Gastroenterol [Internet]. 2009 Aug 10;15(2):121. DOI: https://doi.org/10.4103/1319-3767.48970 [PMid:19568577 PMCid:PMC2702965]

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.