Bile duct worms and what you need to know

This is an automatically translated article.

The article was consulted professionally with MSc Vu Tan Phuc - Department of Medical Examination & Internal Medicine, Vinmec Phu Quoc International General Hospital.
Bile duct worms were a fairly common disease in the past due to the high prevalence of helminth infections. Today, with the effectiveness of prevention and periodic deworming, the incidence of disease has greatly reduced in the community. Bile duct worms occur when the worm population increases in large numbers in the gastrointestinal tract and causes them to migrate backwards up the biliary system.

1. Overview of bile duct worms

Bile duct worms are a complication of worm infections in the gastrointestinal tract. Small intestinal worms can migrate up the duodenum, to the oddi sphincter, and into the common bile duct, common hepatic duct, cystic duct, and intrahepatic biliary system. Into the biliary tract, the worms can live as parasites in place, the worm carcass after death becomes the nucleus to form gallstones later. Complications of bile duct worms can be biliary tract infection, biliary tract abscess, liver abscess. Bile duct worms can occur at any age but are more common in children under 10 years of age. Predisposing factors that increase the likelihood of disease include low protein diet, thin body, low acidity of gastric juice and infectious diseases.

2. Why do worms enter the bile duct?

The biliary system in the body is divided into two parts, intrahepatic and extrahepatic. The extrahepatic biliary tract includes the common hepatic duct, the cystic duct, the gallbladder and the common bile duct communicating with the digestive system in the duodenum to form the ampulla of the vater. The opening of the common bile duct into the duodenal bulb is surrounded by the surrounding oddi sphincter, which opens when bile enters the intestine to digest food. Bile duct worms are worms that travel backwards from the small intestine into the bile duct through the foramen sphincter of Oddi. Roundworm with a long tubular shape like a chopstick is the most common type of worm that enters the bile duct.
An excessive number of worms in the small intestine is one of the factors required for worms to enter the bile duct. At that time, the source of nutrients in the small intestine is not enough, they must move to other environments in the human body. It is also the most common cause of bile duct worms in children. Eating unhygienic, not drinking or using an ineffective dewormer causes worms to continue to exist and parasitize in the intestinal system. Deworming drugs, when used ineffectively, also cause movement disorders that cause them to move scatteredly, increasing the risk of entering the oddi sphincter in the duodenal bulb and back up to the common bile duct, cystic duct, and pouch. bile and other bile ducts.
In addition, when gastric juice secretion from the stomach decreases acidity, the environment in the intestinal system is no longer suitable for worms, so they will move to other locations to find a better environment. Patients after partial gastric bypass surgery or suffering from infectious diseases that change the endogenous environment in the digestive tract are subjects at a higher risk of worms entering the bile duct when eating unhygienic and Do not deworm periodically.

3. Symptoms of bile duct worms

Bile duct worms manifest clinically with many different symptoms such as:
Abdominal pain: Usually the patient will have pain in the right lower quadrant corresponding to the location of the biliary system. Pain symptoms often appear in episodes, severe pain nature, can spread to the right shoulder. The typical pain-relieving position in bile duct worms is the buttocks-up position. Children are often asked to carry them on their shoulders to feel more comfortable. Vomiting: Nausea and vomiting are also possible symptoms in bile duct worms. If the number of worms is too much, the patient may vomit adult worms. If the worms enter the bile duct causing complications, the patient may have more severe symptoms such as:
High fever, ranging from 38 to 39 degrees Celsius, accompanied by chills if there are biliary abscesses or abscess in the liver. Fatigue, loss of appetite, pale, thin. Dull pain in the right lower quadrant, the sensation of pain replaces the acute pain in the early stage. Jaundice, yellowing of the conjunctiva of the eyes. Examination revealed increased liver size, increased pain to touch, and positive liver fibrillation. When there are abnormal signs suggesting that worms have entered the bile duct, the patient should go to the medical facility as soon as possible to avoid the disease progressing further and causing many dangerous complications.

4. Diagnosis of worms entering the bile duct

In addition to clinical symptoms, the accurate diagnosis of bile duct worms should be based on subclinical tests and imaging tools such as:
Blood count test: With increased white blood cell count High, predominance of neutrophils indicates infection. Bilan infection was positive with elevated erythrocyte sedimentation rate and CRP. Bilirubin is elevated in the presence of biliary obstruction. Liver enzymes within normal values ​​to differentiate from causes of biliary obstruction related to liver disease. Abdominal X-ray helps to differentiate from other causes of acute abdominal pain. Contrast-enhanced cholangiography allows visualization of adult worms or gallstones causing biliary obstruction. Abdominal ultrasound: Observed indirect images reflecting abnormalities in the biliary system such as dilated common hepatic duct, common bile duct lumen has the most non-dynamic echo. Cholangioduodenal endoscopy: is the method with the highest accuracy, having the role of both diagnosis and treatment. Worms can be removed through the endoscope system.

Bile duct worms are dangerous diseases and can leave many complications, but the disease can be prevented by maintaining a hygienic diet and deworming periodically.
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