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IMAGE IN EUS
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 135-136

A child with unexplained etiology of acute pancreatitis diagnosed by endoscopic ultrasound


1 Department of Gastroenterology, Jaswant Rai Specialist Hospital, Saket, Meerut, Uttar Pradesh, India
2 Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, Haryana, India

Date of Submission15-Oct-2013
Date of Acceptance27-Nov-2013
Date of Web Publication2-May-2014

Correspondence Address:
Narendra Singh Choudhary
Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.131042

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How to cite this article:
Sharma M, Choudhary NS, Puri R. A child with unexplained etiology of acute pancreatitis diagnosed by endoscopic ultrasound. Endosc Ultrasound 2014;3:135-6

How to cite this URL:
Sharma M, Choudhary NS, Puri R. A child with unexplained etiology of acute pancreatitis diagnosed by endoscopic ultrasound. Endosc Ultrasound [serial online] 2014 [cited 2021 Mar 8];3:135-6. Available from: http://www.eusjournal.com/text.asp?2014/3/2/135/131042

A 3-year-old child presented with severe abdominal pain radiating to back. His investigations revealed high serum amylase and lipase levels, normal biochemistries and ultrasound abdomen. An endoscopic ultrasound (EUS) was done (with endobronchial ultrasound, Pentax eb-1970 UK), it showed a linear echogenic structure with central linear anechoic defect completely filling pancreatic duct (PD) suggestive of Ascaris as shown in [Figure 1]a and 1b. It was removed with the help of Dormia basket. The child had rapid recovery.
Figure 1: Endoscopic ultrasound image showing a linear echogenic structure with central lucency completely filling pancreatic duct (a, b in different panels)

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  Discussion Top


0 Ascaris lumbricoides is the most common helminthic infection in the world. While intestine is normal habitat of adult worm, occasionally these worms migrate to biliary or PDs. Biliary ascariasis is an uncommon cause of abdominal pain or obstructive jaundice in nonendemic regions, but it is a common cause of pancreatobiliary disease in an endemic region. Biliary symptoms (pain, and cholangitis) are more common than acute pancreatitis. [1],[2] Migration of worm in the bile duct is more common than PD, probably due to a smaller size of PD, in a series of 500 pancreatobiliary ascariasis, only seven cases had pancreatic ascariasis. [2] In a study form Kashmir (endemic area for ascariasis in India), Ascaris was etiologic factor in 59/256 (23%) cases of acute pancreatitis. Of these 59 cases, 51 patients had a worm in the bile duct, four in PD and four in both ducts. [3] Ascaris appears as four lines sign in PD on ultrasound. [4] On EUS, Ascaris lumbricoides appears as long echogenic structure with central anechoic linear defect, without producing shadow effect [Figure 2], common bile duct Ascaris]. [5] Ascaris induced pancreatitis is generally mild and worm extraction is associated with rapid relief of symptoms. [3]
Figure 2: Endoscopic ultrasound image showing a linear echogenic structure with central lucency without acoustic shadow effect in common bile duct

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  References Top

1.Sandouk F, Haffar S, Zada MM, et al. Pancreatic-biliary ascariasis: Experience of 300 cases. Am J Gastroenterol 1997;92:2264-7.  Back to cited text no. 1
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2.Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet 1990;335:1503-6.  Back to cited text no. 2
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3.Khuroo MS, Zargar SA, Yattoo GN, et al. Ascaris-induced acute pancreatitis. Br J Surg 1992;79:1335-8.  Back to cited text no. 3
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4.Price J, Leung JW. Ultrasound diagnosis of Ascaris lumbricoides in the pancreatic duct: The "four-lines" sign. Br J Radiol 1988;61:411-3.  Back to cited text no. 4
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5.Sharma M, Garg S. Endoscopic ultrasound for ascariasis in common bile duct. Endoscopy 2009;41 Suppl 2:E209-10.  Back to cited text no. 5
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    Figures

  [Figure 1], [Figure 2]


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