Ascaris lumbricoides Infestation of Bile Ducts: Case Report

Background: Ascariasis is a common helminthic disease that affects the gastrointestinal tract of human beings and is caused by the Ascaris lumbricoid worm. Most of the time, this parasite resides in the intestinal lumen, but it can occasionally travel to the biliary tract through the ampulla of Vater. The most serious and potentially fatal complication of intestinal ascariasis is biliary ascariasis, which can appear in different ways.

Case Report: A non-diabetic, non-alcoholic female reported to the emergency department with a one-day history of abdominal pain and vomiting with worms. The pain began gradually with a score of 7/10 and rapidly deteriorated during the day, reaching 10/10 at the hospital presentation. The patient also had a significant medical history. Before papillotomy, she underwent endoscopic retrograde cholangiopancreatography with the removal of one common bile duct (CBD) stone, but no stent was implanted. She had her laparoscopic cholecystectomy done as well. Laboratory examination revealed normal liver function tests and C-reactive protein. While abdominal ultrasound confirmed the presence of hepatic pericholangitis and on ultrasound imaging, the CBD was found to be enlarged approximately 7 mm in diameter and had a linear tubular structure with centre faint echogenicity and periphery tubularity. The ultimate diagnosis of the patient was cholangitis brought on by Ascaris lumbricoides. After the diagnosis, endoscopic retrograde cholangiopancreatography showed sphincterotomy with CBD dilation. The worm was extracted by grasping it with biopsy forceps and pulled out of the papilla using a balloon catheter. The length of the worm was 18 centimeters.

Conclusion: Ascaris is the most frequently occurring disease that can cause biliary complications, such as cholangitis. This case report suggests that cholangitis caused by Ascaris lumbricoides can be successfully treated with the endoscopic approach, indicating that endoscopy could be a viable option to manage ascaris.