Unmasking an Incidental Trichuris trichiura Infection in a Patient With Acute Hepatobiliary and Gastrointestinal Illness

Abstract

Background

Trichuris trichiura is a common intestinal parasite, but its systemic impact remains unclear. While severe infections may cause gastrointestinal complications, hepatobiliary involvement is rare. This case describes an incidental T. trichiura infection identified during colonoscopy in a patient hospitalized with acute pancreatitis and suspected gastric outlet obstruction. The study underscores the importance of differentiating incidental parasitic infections from true pathology to prevent misdiagnosis and unnecessary treatment.

Case Presentation

A 52-year-old female presented with persistent nausea, vomiting, postprandial discomfort, and weight loss for 2 weeks. Imaging revealed hepatomegaly and gastric distension, raising concerns for gastric outlet obstruction or severe gastritis. Laboratory findings showed elevated liver enzymes (ALT: 101 IU/L, Alk-P: 189 IU/L, r-GT: 288 U/L). A viral etiology was suspected but not confirmed. The patient received supportive intravenous therapy, and her symptoms resolved. Colonoscopy revealed a partially clamped T. trichiura adult worm in the transverse colon. Given her clinical improvement without anthelmintic treatment, the infection was deemed incidental and not causative.

Conclusion

This case highlights the need to critically evaluate incidental parasitic infections before attributing them to clinical symptoms. Routine screening is valuable but should be accompanied by a thorough assessment of parasite burden, patient history, and clinical presentation to guide appropriate management and prevent unnecessary interventions.