Post written by Vikas Sengar, MD, DM, Alok Gupta, MD, DM, and Arun Khanduri, MD, DM, from the Department of Gastroenterology, Medihelp Hospital, Kanpur, India.

As gastroenterologists practicing in India, we frequently encounter patients with worms in the gut. They may be as tiny as pinworms and as huge as Taenia (tapeworms). They suck blood and food materials and sometimes block the intestine.

The roundworm (Ascaris) is particularly notorious, as it is highly motile and has a tendency to enter the bile and pancreatic ducts. This sometime causes serious diseases such as acute cholecystitis, cholangitis, and acute pancreatitis.

A young woman presented with agonizing abdominal pain of 3-day duration. US showed Ascaris in the main pancreatic duct. While we attempted removal of the worm, it went completely inside the main pancreatic duct, but we removed it with the help of a pancreatoscope directly under vision. Postprocedure, she was asymptomatic and discharged the next day without clinical or biochemical evidence of pancreatitis.

A dangerous situation was averted with quick decision-making and use of recently available modern technology. A live Ascaris invaded the main pancreatic duct, causing severe, intolerable pain. Obstruction of the pancreatic duct often causes acute pancreatitis. Once the pathophysiological cascade of acute pancreatitis is set in motion, the process cannot be halted. We immediately decided to remove the worm before the cascade set in.

Because the worm retracted completely inside the pancreatic duct and blind attempts by instrumentation could be harmful in the patient, we decided to remove it under vision by using novel technology. Although removal of a pancreatic duct stone and migrated stent has been performed using pancreatoscopy, we could not readily access reference of live objects such as Ascaris. 

This case illustrates that understanding of pathophysiology, application of clinical acumen, and quick decision-making along with innovative use of novel technology can save precious lives.

Pancreatoscopic image showing an Ascaris inside the main pancreatic duct.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.