II. Differential Diagnosis

II. Differential Diagnosis

1. Cholecystitis and Cholelithiasis

Cholecystitis and cholelithiasis share similarities with biliary ascariasis in terms of presenting with colicky pain. However, patients with cholecystitis or cholelithiasis have a history of chronic illness, and their pain does not exhibit the "drilling" sensation. Even during remission, the pain and tenderness do not completely disappear, and there is still obvious tenderness in the right upper quadrant, with abdominal muscle tension, often accompanied by fever and jaundice. These conditions are more common in adults.

2. Acute Pancreatitis

The pain associated with acute pancreatitis is persistent, localized mainly to the left upper quadrant, and serum amylase testing can aid in diagnosis. However, since biliary ascariasis can obstruct the pancreatic duct, impeding the excretion of pancreatic juice and potentially leading to acute pancreatitis, clinicians should pay close attention, especially when patients are so tormented by pain that they cannot clearly describe its nature and location, prompting timely laboratory testing.

3. Perforated Gastric or Duodenal Ulcer

When gastric or duodenal ulcers result in perforation, the pain becomes persistent, initially localized to the upper abdomen and gradually spreading throughout the abdomen, accompanied by marked tenderness and rebound tenderness, as well as "board-like" rigidity of the abdominal muscles (abdominal muscle tension). Abdominal X-ray examination may reveal free gas beneath the diaphragm. Patients often have a history of chronic ulcers.

4. Gastric Spasm

Gastric spasm frequently occurs in patients with ulcers, acute gastritis, chronic gastritis, gastric and duodenal diverticula, and gastric neurosis, often linked to exposure to cold, irregular eating habits, excessive mental stress, and depression. The pain is persistent, and analgesics, antispasmodics, and acupuncture therapy often prove effective.

Section 3: Integrated Traditional Chinese and Western Medical Treatment

Currently, the primary approach to treating biliary ascariasis is an integrated combination of traditional Chinese and Western medicine, employing a variety of therapies—including antispasmodics and analgesics, deworming and expelling parasites, anti-inflammatory and cholagogue treatments—in a comprehensive manner, often achieving excellent therapeutic outcomes.