Objectives: Biliary ascariasis is a serious problem in children. Its early diagnosis and management is essential for survival of children. In order to find out incidence, investigational profile, therapeutic modality of biliary ascariasis in children the following study was conducted.

Method: The children(less than 10 years) who came to attend Pediatric Gastroenterology OPD in PGIMER Chandigarh from July 1993 to June 2003 with history suggestive of hepatobiliary/pancreatic/ascariasis (e.g. round worm expulsion/ abdominal pain/ vomiting/ jaundice etc.) were admitted to pediatric gastroente-rology ward. Detailed history taking /clinical examination/ investigation (USG whole abdomen/ MRCP/ LFT/amylase/lipase/PTI/ERCP etc. as per individual case) were done. During ERCP, worms were extracted from duodenal papilla by snare/dormia basket. IV fluid /IV antibiotic / NPO/nasobiliary drainage etc. were done.

Results: Fifty cases of biliary ascariasis in children were admitted. Age was 3-10 years (mean – 6 years). Out of 50 cases,45(90%) had abdominal pain,25(50%) had cholangitis, 15(30%)had jaundice,50(100%) had vomiting. In ERCP, worms were extracted by snare /dormia basket. Double pigtail plastic biliary stent was deployed in 30(60%) cases. Nasobiliary drainage was done in 10(20%) cases. IV drip/inj.antibiotic etc. were done. After removable of worms, all of the 50cases recovered remarkably. There was up and down movement of worms in bile duct and hepatic duct. None developed cholangitic abscess/ hepaticabscess/ hemobilia/hepatobiliary stone in subsequent follow up.

Conclusion: Biliary ascariasis is a serious problem in children. Endoscopic management is very much useful to tackle this problem

Keyword: Biliary ascariasis, children.

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Sujay Chaudhuri

Division of Pediatric Gastroenterology, Department of Gastroenterology, PGIMER Chandigarh

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