Parasites and Biliary stones

Ascariasis ١٠
migration. Symptoms develop 9–12 days after ingestion of the eggs and
last from 2 to 3 weeks. The hallmark of Loeffler’s syndrome is fleeting
pulmonary infiltrates on chest X-ray, often accompanied by peripheral
eosinophilia. Also appendiceal Ascariasis is a relatively rare complication
of A. lumbricoides infection. The phenomenon by which this occurs is
due to the Ascarid entering the appendiceal lumen, advancing to the tip of
the appendix and causing ischemic necrosis and gangrene of the epithelial
layer (Schuster et al., 1977).
Diagnosis:
Laboratory studies:
Stool examination may show ascaris ova or remnants of dead worm
(Khuroo et al., 1990). In uncomplicated biliary ascarasis,the peripheral
white blood cell counts usually normal,so leucocytosis is associated with
suppurative biliary and hepatic complications (Lloyd, 1982).
Imaging studies:
Ultrasound is the diagnostic method of choice and the adult living
worm can easily be identified by its characteristic slow, pendular, non-
directional movements (the zig-zag sign) and its tube-like appearance
consisting of three or four parallel echogenic lines in the longitudinal axis
and the target sign or ‘‘bull’s eye’’ in the transverse axis. Its lumen can
only be seen when distended with fluid using a high frequency ultrasound
transducer (Koumanidou et al., 2004). Multiple Ascaris worms can fill
up the whole duct causing a spaghetti-like appearance, can form a
hyperechoic intrahepatic tumour-like mass, or when dead, can mimic
medical devices (Schulman, 1998).
ERCP is an excellent diagnostic tool and helpful during the active
phase and sometimes worms may be seen moving actively into the biliary