A Case Of Idiopathic Acute Pancreatitis Demystified by Endoscopic Ultrasound

Background and Aims: Ascaris lumbricoides is a common cause of acute pancreatitis in developing countries. The mechanism of acute pancreatitis in ascariasis may be due to obstruction of papilla of Vater, invasion of common bile duct (CBD), or pancreatic duct (PD). The invasion of PD occurs rarely owing to its smaller caliber. Ultrasonography (USG) is an effective tool for the diagnosis of biliary and pancreatic ascariasis; however, the diagnosis may be false negative in up to 30% of cases. The aims of this case study is to evaluate the usefulness of Endoscopic ultrasound in work up of idiopathic pancreatitis.

Methods: Endoscopic ultrasound (EUS) for diagnosis linear echoendoscope (Pentax EG 3830 UT, Japan) Hitachi Avius-processor at 7.5 MHz frequency was used .It showed heterogenous echotexture with multiple hypoechoic areas noted in head, body and tail of pancreas. MPD is dilated in head measuring 4 mm. Hyperechoic linear lesion in the MPD (from genu to mid body)—suggestive of roundworm.

Result: ERCP performed on same day—dilated MPD with dilated side branches with long, linear filling defects, suggestive of worm. Multiple balloon sweeps taken and single worm removed. A stent placed across MPD. Patient got symptomatic relief. Anthelmintics—Tablet Albendazole 400 mg stat was given. After 1 month follow-up there is complete resolution of symptoms. On Monthly follow-up for 6 months, she was asymptomatic and there are no recurrence of pancreatitis.

Conclusion: Ascariasis-induced acute pancreatitis is mild and EUS is the investigation of choice. The recurrence is rare and treatment is side viewing endoscopy with removal of worms. Although USG is quite sensitive for diagnosing biliary and pancreatic ascariasis, its sensitivity significantly falls when the worm is thin, in the PD, or the CBD is nondilated. EUS should be used early in the workup of idiopathic acute pancreatitis after the first episode.

Publication History

Article published online:
22 April 2024