What is the treatment for worm infestation of the gallbladder?

Treatment of Worm Infestation of the Gallbladder

For gallbladder ascariasis, initial management should be conservative medical treatment with albendazole 400 mg as a single oral dose, with close ultrasound monitoring for spontaneous worm migration back to the intestine, reserving surgical intervention only for cases with impacted worms that fail to exit after conservative treatment. 1, 2

Initial Diagnostic Approach

• Ultrasound is the diagnostic modality of choice, showing linear echogenic tubular structures in the gallbladder lumen with characteristic "belly dance" or zigzag coiling movements on real-time B-mode imaging 1, 2
• Repeat ultrasound examinations frequently to monitor worm movement and migration patterns 2
• Assess for concurrent bile duct involvement, as approximately 10% of gallbladder ascariasis cases have associated common bile duct worms 2

Medical Management (First-Line)

Albendazole 400 mg orally as a single dose is the recommended anthelminthic treatment 1, 3

Expected Clinical Course with Conservative Treatment

• Spontaneous worm migration back to the duodenum occurs in approximately 79% of cases (22 of 28 patients in the largest case series) 2
• Time to spontaneous exit ranges from 1 hour to 144 hours (6 days) after diagnosis 2
• Continue ultrasound monitoring during this period to document worm migration 2
• The narrow and tortuous anatomy of the cystic duct makes gallbladder entry rare, but also allows for potential spontaneous exit 4, 2

Clinical Presentations to Recognize

• Acute acalculous cholecystitis is the most common presentation (75% of cases), manifesting as right upper quadrant pain, fever, and vomiting 2, 1
• Biliary colic without acute inflammation occurs in approximately 25% of cases 2
• Dead or calcified worms may be present in chronic cases 2

Surgical Intervention (Reserved for Treatment Failures)

Cholecystectomy is indicated only when:

• Multiple impacted worms fail to exit spontaneously after conservative medical treatment 2
• Dead or fragmented worms remain in the gallbladder causing persistent symptoms 2
• Approximately 21% of cases (6 of 28 patients) required surgical intervention in the largest series 2

Critical Management Pitfalls

• Do not rush to surgery – the majority of cases resolve with medical management and observation 2
• Intravenous cholangiography can visualize worms when obstructive jaundice is absent, providing diagnostic confirmation 5
• Consider that biliary ascariasis is underrecognized in non-endemic regions, leading to potential diagnostic delays 5

Alternative Worm Species Considerations

While Ascaris lumbricoides is the causative organism in gallbladder worm infestations 1, 6, 4, if other helminthic infections are suspected based on travel history or clinical presentation, broader anthelminthic coverage may be warranted with the same albendazole dosing 3