Helminth-induced pancreatitis : case report and literature review

Abstract

Hepatobiliary and pancreatic ascariasis is a rare cause of pancreatitis in the Western World, with only individual cases reported. We present the case of a 24-year-old man who presented with a 3-month history of recurrent abdominal and back pain, bloating, nausea, anorexia and cachexia. Pancreatitis was confirmed with blood investigations and CT scan. No causative factors were identified on abdominal US, MR cholangiopancreatography or endoscopic US. The patient claimed to notice worm fragments in his feces three months after initial presentation. Fecal analysis confirmed the presence of helminth fragments, suggesting hepatobiliary and pancreatic ascariasis despite lack of travel to endemic regions. The patient was treated with mebendazole 100 mg bid for 3 days which resolved his symptoms completely. He remained well at 12-month follow-up. Fecal analysis should be considered in patients with pancreatitis of unknown etiology.