Saudi Journal of Gastroenterology
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LETTER TO EDITOR  
Year : 2017  |  Volume : 23  |  Issue : 5  |  Page : 306
Ascariasis and pancreatitis


Department of Surgical Gastroenterology, Consultant Endoscopic and Laparoscopic Surgeon, Ronak Endo-laparoscopy and General Surgical Hospital, Patan, Gujarat, India

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Date of Web Publication18-Sep-2017
 

How to cite this article:
Yagnik VD. Ascariasis and pancreatitis. Saudi J Gastroenterol 2017;23:306

How to cite this URL:
Yagnik VD. Ascariasis and pancreatitis. Saudi J Gastroenterol [serial online] 2017 [cited 2019 Sep 17];23:306. Available from: http://www.saudijgastro.com/text.asp?2017/23/5/306/215042


Sir,

I read with great interest an article entitled, “A rare etiology of idiopathic acute pancreatitis” by Sharma et al.[1] It is an interesting and unusual case. I would like to congratulate the authors for their excellent effort. However, I have a few observations in this connection.

The authors of the report mention that ultrasonography (USG) has low sensitivity for pancreatic duct ascariasis. I would like to state that USG is a simple, quick, safe, noninvasive, and highly accurate test reflecting the ascariasis morphology, which may be single or multiple, long, linear echogenic strips without acoustic shadowing in the biliary or pancreatic ducts (strip sign).[2]

In this case, magnetic resonance cholangiopancreatography (MRCP) was normal. Studies have shown that MRCP and endo-sonography are comparable in the presence of nondilated common bile duct.[3] The failure to diagnose on USG and MRCP in the index case may be due to the migration of the worm, which may move freely in and out of the bile or pancreatic duct. In most patients worms move out of the duct within 24 hours of inducing symptoms. Real-time USG also monitors the exit of the worm through the biliary tree or pancreatic duct. Worm in the duodenum is hard to diagnose by USG. A review of 300 patients showed that ultrasound and clinical findings are the mainstays of diagnosing pancreatitis secondary to ascariasis.[4]

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Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Sharma M, Somani P. A rare etiology of idiopathic acute pancreatitis. Saudi J Gastroenterol 2017;23:209-10.  Back to cited text no. 1
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2.
Ferreyra NP, Cerri GG. Ascariasis of the alimentary tract, liver, pancreas and biliary system: Its diagnosis by ultrasonography. Hepatogastroenterology 1998;45:932-7.  Back to cited text no. 2
[PUBMED]    
3.
Kondo S, Isayama H, Akahane M, Toda N, Sasahira N, Nakai Y, et al. Detection of common bile duct stones: Comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed tomographic cholangiography. Eur J Radiol 2005;54:271-5.  Back to cited text no. 3
[PUBMED]    
4.
Sandouk F, Haffar S, Zada M, Graham DY, Anand BS. Pancreatic-biliary ascariasis: Experience of 300 cases. Am J Gastroenterol 1997;92:2264-7.  Back to cited text no. 4
    

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Correspondence Address:
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjg.SJG_301_17

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