You slimy li’l monster!

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.


The round worm being snared out of the duodenal papilla.

The round worm being snared out of the duodenal papilla.

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.

Look at the size of that thing!

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!


About Zed

Public ramblings of a young doctor trying to make it large.. View all posts by Zed

3 responses to “You slimy li’l monster!

  • Pranab

    Fantastic post to mark your return to the blogosphere. Hope to read more from you… and awesome way for you GI consultant to hunt down such a zebra. Cool case. 🙂

    P.S.: Have you considered patient confidentiality etc issues? Is that pic of the real procedure? Did you take patient/consultant consent? Am I being a pain in the back? 😛

  • Zed

    Thanks a ton! I will try and be a regular, although sometimes I really have nothing to write about.

    P.S. : Yes I did take (verbal) consent from both the patient and the consultant. And yes that is a picture I took during the ERCP/endoscopy.

    And of course you’re being a pain in the back! 🙂

  • tutorials

    Probably this blogs greatest piece yet!!!

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