Haven’t blogged in a while now, but I thought this case was worth writing about.
A 16 year old female presented to the ER a couple of days back with severe intractable abdominal pain along with vomiting. She was febrile, looked pretty toxic and had severe epigastric tenderness on examination.
Her serum Lipase was through the roof, and her Amylase levels as well as her liver enzymes had shown a steep rise over the night. Our GI consultant came up with a diagnosis I would never have thought of. Considering the patient was from a poorer part of the country he suspected Ascariasis (Round worms) as a possible cause, although the abdominal ultrasound had not revealed any such findings.
And sure enough, on ERCP we found a huge round worm trying to make an escape back up the Ampulla of Vater (which the pancreatic and biliary duct drain into). Another much smaller worm, perhaps the male worm, was found lazying around in the stomach and was taken care of too.
After confirming there were no other worms inside the pancreaticobiliary tree and the rest of the upper GI tract, the patient was started on Albendazole. A day later she had already started showing improvement in her symptoms and her liver and pancreatic enzyme levels had started to drop again.
Walking out of the endoscopy room, the ecstatic Gastroenterologist, having got the diagnosis spot on even before the ERCP, said, “..this is what grey hair does to you, you don’t miss a lot at my age!“