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The presence of ascarids in the common bile duct or biliary radicals may be detected by intravenous, T-tube or transhepatic cholangiography, readily identifying their smooth, cylindrical radiolucent outlines (Figs. 10.26, 10.27, 10.28). Tomography considerably improves the demonstration of these worms when intravenous cholangiography is employed (Fig. 10.28C). Rarely during an upper gastrointestinal series, reflux of barium from the duodenum into the biliary tract through a postoperative or otherwise incompetent sphincter of Oddi may demonstrate one or more ascarids in the common duct. Not infrequently in a heavy infection, there may be several worms tangled together within the common duct and biliary radicals amidst other filling defects caused by biliary sludge and stones (Fig. 10.27). If the patient has in addition an ascending or recurrent cholangitis, there may be alternating strictures and dilatations of the biliary radicals (Fig. 10.27A).
Fig. 10.26 A-D. (A) Ascaris in the common bile duct demonstrated by T-tube cholangiogram. This adult worm is passing from the duodenal C-loop through the Vaterian segment into the common duct. The pancreatic duct is also visualized. (B) Autopsy specimen from another patient showing an adult Ascaris migrating from the duodenal C-loop into the ampulla of Vater (right). (C) Ascaris in the common bile duct of a 38-year-old woman from Colombia, South America. This patient also had calculi in her gallbladder, a not infrequent association with biliary ascariasis. (Courtesy of Dr. William Thomas, McLean, Virginia.) (D) Cross-section of an adult Ascaris in a dilated bile duct. The cuticle, hypodermis, lateral cords, and intestinal tract (center of worm) are all illustrated. X14. AFIP 55-2261-3.
Fig. 10.27. Ascariasis of the biliary tract in two different patients from South America. A T-tube cholangiogram reveals the radiolucent outlines of multiple ascarids within the common duct and biliary radicals of a patient from Colombia (A), and another from Brazil (B). Biliary sand, sludge, and stones are often present in patients with severe biliary ascariasis. (C) Autopsy specimen of the liver and biliary tract showing multiple adult ascarids within the dilated common bile duct and biliary radicals in another patient from Brazil. (D) Cross-section of the same liver showing numerous adult ascarids within dilated biliary ducts. (B, C and D Courtesy of Dr. Antonio Filho, Sao Paulo).
Fig. 10.28. Ascariasis of the biliary ducts in three different patients identified by intravenous cholangiography with and without tomography. (A) The radiolucent outline of a single Ascaris is clearly seen in the dilated common bile duct of a Brazilian. (B) The radiolucent outlines of multiple ascarids are seen in the common duct and biliary radicals on an intravenous cholangiogram of another patient from Brazil (Courtesy of Dr. Antonio Filho, Sao Paulo.) (C) A lone Ascaris is identified in the dilated common duct on this tomographic cut from an IV cholangiogram of a child from South Africa (same patient as Fig. 10.13D). Tomography is a very useful adjunct to intravenous cholangiography.
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Copyright: Palmer and Reeder
