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Case Reports
. 2024 Jun 11;17(6):e260316.
doi: 10.1136/bcr-2024-260316.

Acute necrotising pancreatitis from ascariasis in a gravid patient

Vernon Chuabio  1 , Maria Rina Lanoy  2 , Mark Anthony De Lusong  3
Affiliations
Case Reports

Acute necrotising pancreatitis from ascariasis in a gravid patient

Vernon Chuabio et al. BMJ Case Rep. .

Abstract

Rarer causes of acute pancreatitis may be considered in certain settings, such as parasitism in endemic regions. This report describes a pregnant female (second trimester) in her 20s who presented with 3-day steady epigastric pain radiating to the back and passage of worm from the mouth. She was diagnosed with mild acute pancreatitis, given a significantly elevated serum lipase and absence of organ failures. Fecalysis showed Ascaris lumbricoides ova; hence, she was treated with mebendazole. Plain MR cholangiopancreatography showed an 842 mL necrotic pancreatic fluid collection and tubular flow void foci within the gallbladder and duodenum consistent with helminthiasis. The patient was managed conservatively in the absence of indications for drainage. The abdominal pain remarkably improved, and she underwent eventual vacuum-assisted delivery to a healthy term baby 4 months after the bout of acute pancreatitis.

Keywords: Hepatitis and other GI infections; Pancreatitis; Pregnancy; Radiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ascaris lumbricoides ova on faecal smear. The images show A. lumbricoides ova seen on direct faecal smear (wet mount examination).
Figure 2
Figure 2
Necrotising pancreatitis with acute necrotic collection. These axial MRCP images show an 842 mL well-defined air-filled and fluid-filled cavity (yellow arrow) with thick and irregular border involving the tail of the pancreas and peripancreatic regions with surrounding fat stranding. MRCP, MR cholangiopancreatography.
Figure 3
Figure 3
MRCP images of gallbladder. The gallbladder is contracted, precluding adequate assessment. However, a tubular flow void (yellow arrow) is imaged within its lumen, as seen in these axial (left image) and coronal (right image) cuts. MRCP, MR cholangiopancreatography.
Figure 4
Figure 4
MRCP images of descending duodenal portion. A tubular flow void focus (yellow arrow) is seen within the descending segment of the duodenum (D2), as shown in these axial (left image) and coronal (right image) cuts. MRCP, MR cholangiopancreatography.
See this image and copyright information in PMC

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