It has been generally known that the management of Acute Pancreatitis should be done by conservative treatment. Elliot, however, said, "Early emergency operation is justified for: 1) a doubtful diagnosis, 2) acute cholecystitis accompanied by acute pancreatitis, or 3) an acutely enlarging pancreatic abscess or pseudocyst." And David stid, "It has also been suggested that prompt drainage of the common bile duct during the early stage of acute pancreatitis might be effective in decreasing intraductal pressure within the pancreas and thereby might abort what otherwise might be a prolonged and serious attack."
Authors have experienced 4 cases of acute pancreatitis due to impaction of Round Worm into the pancreatic duct during the past 8 months, from October 1966 to June 1967, and in all of these patients dramatic, valuable effect was obtained by emergency operation.
The following are summaries of clinical observations made on the above mentioned cases:
1) In countries with high incidence of round worm infestation such as Korea, the physician should consider that acute pancreatitis may be caused by round worm.
2) In these acute pancreatitis caused by round worm. early operation must be indicated, since complications or serious catastrophe might be prevented by early operation.
3) It is an interesting fact that in these 4 cases, all were females, and had no past history of biliary, pancreatic, or diseases caused by an abuse of alcohol. Authors think that these features might be helpful in diagnosis and confirmation of Acute Pancreatitis caused by Round Worm.
4) During the operation, if the evidence of acute pancreatitis is found inpaction of round worm into the pancreatic duct can be confirmed by duodenotomy only.
5) According to the author´s 4 cases of Acute Pancreatitis caused by Round Worm, the operatiye gross pathology of all the cases, was typically acute edematous pancreatitis, showing an accumulation of serous exudate in the abdominal cavity, diffuse fat necrosis, and a distended pancreas; and since these patients had an operation within one week from the first attack, the authors think that hereafter such cases will be curable without complications, if early, prompt operation is performed.
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