P-HPB-20: Pancreatic ascariasis as an unusual cause of recurrent pancreatitis: An endoscopic ultrasound diagnosis

BACKGROUND: Ascaris lumbricoides infestation is endemic in tropical countries. Most infections are asymptomatic, but it can produce a wide spectrum of manifestations including hepatobiliary and pancreatic complications. Biliopancreatic ascariasis is rare outside the endemic regions. CASE REPORT: We report a case of recurrent pancreatitis, symptomatic for the last 2 years, multiple hospitalizations, various imagings with ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography failed to establish the etiology, and endoscopic ultrasound revealed an adult A. lumbricoides worm inside the main pancreatic duct. The patient underwent endoscopic retrograde cholangiopancreatography with extraction of the dead worm; deworming was done with albendazole 400 mg, single dose. Patient is symptom-free for the last 1 year. DISCUSSION AND CONCLUSION: Biliary ascariasis is a common occurrence in endemic regions and is causally associated with biliary colic, acute cholangitis, acute pancreatitis and its complications, recurrent pyogenic cholangitis, acute cholecystitis, and liver abscess. Secondary to smaller duct diameter, migration of A. lumbricoides into the pancreatic duct is uncommon. Even in highly endemic areas such as Kashmir, India, pancreatic ascariasis was rare and represented only 1.4% of all hepatobiliopancreatic ascariasis. Endoscopy ultrasound is a useful modality in diagnosis and management of patients with pancreatic ascariasis.