Rare case of Pancreatitis

Abstract

Ascaris lumbricoides is one of the most common intestinal parasites world-wide and although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. We describe a case of 32 year old female who presented to the Emergency Department with acute upper abdominal pain with constipation for 5 days, fever for 3 days and vomiting for 2 days. Her family is running an Orphanage in Trivandrum with a total number of 32 inmates majority of them being from North Indian states.  On examination, she had agonising pain, tenderness in the epigastrium, bowel sounds were sluggish. There was leucocytosis, elevated amylase and lipase levels, hypoalbuminaemia. Ultrasound showed inflammatory changes in the pancreatic body with peripancreatic free fluid, confirmed by plain CT and MRI abdomen. The patient was given intravenous antibiotics. On day 6 of hospital stay, the patient developed loose stools followed by an episode of vomiting. Her vomitus contained a single adult female Ascaris worm. Stool routine examination was normal. The patient was started on Albendazole. Oro-gastro-duodenoscopy showed a lax LES with antral erythema and an adult female Ascaris worm was seen invading the ampulla of Vater and was retrieved. 2 weeks later she coughed out an adult male worm. A repeat Stool routine examination showed fertilized eggs of Ascaris. Ascariasis is a rare cause of pancreatitis. The pathogenesis of Ascaris induced pancreatitis is that of the obstructive one and due to the “wanderlust” of the worm. When a patient presents with clinical features of pancreatitis, a possibility of Ascaris induced pancreatitis should be thought of.  

KEYWORDS-  Ascariasis, Pancreatitis , Roundworm