- 期刊
Biliary Ascariasis Induced Acute Pancreatitis: A Case Report
膽道蛔蟲症併發急性胰臟炎：一病例報告
摘要
蛔虫症是人類最常見的蠕蟲感染，當牠移行入膽道可引起膽管阻塞、膽管炎、肝膿瘍或胰臟炎。雖然在一些流行地區這些併發症仍屬常見，但在台灣已非常稀罕。本科於86年2月經歷一例蛔蟲阻塞總膽管併發急性胰臟炎，患者為60歲家庭主婦半年前曾到過越南及中國大陸地區，因急性腹痛而來就診，實驗室中檢查顯示血清澱粉酶及脂肪酶異常升高，而腹部超因波發現總膽管擴張，其中有兩個小的高迴音影象，初以為總膽管結石併發膽管炎及胰臟炎，後由內視鏡逆行性膽胰管攝影發現在總膽管內有一條蠕動折屈的蛔蟲，並以籃網經由內視鏡將蟲體取出，之後腹痛消失，並給予三日抗蛔蟲藥（mebendazole），無蛔蟲解出，於門診追蹤治療。此病例與海外旅遊雖無直接證據，但仍相當有關。隨著國人海外旅遊及移民增加，此類病例在未來仍可能被發現，不容忽略。
並列摘要
Ascariasis is one of the most common helminthic diseases in humans. Migration of ＂Ascaris lumbricoides＂ into the biliary tree may cause acute cholangitis, acute cholecystitis, biliary colic, acute pancreatitis or hepatic abscess. We report a case of acute pancreatitis caused by a live worm that obstructed the common bile duct. A 60-year-old housewife presented at our hospital, half an year after traveling to Mainland China and Vietnam. She complained of severe epigastric pain with vomiting for one day. Abnormally high serum amylase and lipase were found. Abdominal ultrasonography showed two small, round, echogenic lesions inside the dilated common bile duct in transverse section. Common bile duct stone with cholangitis and acute pancreatitis were suspected initially. One week later, endoscopic retrograde cholangiopancreatography showed an actively moving tubular filling defect in the common bile duct. Endoscopic removal of the worm was performed with an endoscopic basket after an sphincterotomy. Abdominal pain resolved rapidly after worm extraction and oral administration of mebendazole 100 mg twice daily for three days. There was no worm on stool passage. We consider that world travel is closely related with the ascaris infection in this case, although there was no direct evidence. As a result of increased population migration and world travel, such case will be found in the future.
延伸閱讀
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