Cholangitis caused by [f10]Ascaris

Ascaris worms sometimes crawl up into a patient's common bile-duct and gall-bladder, where they can cause biliary colic, acute cholecystitis, obstructive jaundice, and cholangitis. This most often happens when a child has been given an antihelminthic. So, if a child has cholangitis, or if an adult does not fit the usual clinical picture for biliary disease, suspect Ascariasis. Finding Ascaris ova should arouse your suspicion, but does not confirm the diagnosis. Do an intravenous cholangiogram when the jaundice is ebbing[md]it may outline the worms. Don't operate, except on the indications below.

ASCARIS CHOLANGITIS Nasogastric suction will rest the child's upper intestinal tract. Systemic antibiotics will help to control his cholangitis. Later, give him piperazine or mebendazole.

INDICATIONS FOR SURGERY. Deepening jaundice, spiking fever, chills and rigors which do not respond to antibiotics; nausea and vomiting, toxaemia, dehydration, tachycardia, and perhaps hypotension; together with a leucocytosis. If he has these symptoms, explore and drain his bile-ducts (choledochostomy), as in Section 13.4. Remove any worms you find.