Biliary Ascariasis

This case features a 75-year-old man from southwestern Colombia presenting with 3 weeks of fever, pale stools, jaundice, and colicky right upper quadrant pain. He had limited access to clean water. Labs revealed leukocytosis (24,870/µL) with neutrophilia and elevated conjugated bilirubin (3.8 mg/dL). Ultrasound identified echogenic tubular structures in the common bile duct, causing intrahepatic and extrahepatic bile-duct dilation. ERCP visualized a live Ascaris lumbricoides worm protruding from the ampulla, followed by the removal of two additional worms using a balloon catheter. Diagnosis: biliary ascariasis with secondary cholangitis. Treatment included albendazole and piperacillin–tazobactam, with symptom resolution within one week.

This case features a 75-year-old man from southwestern Colombia presenting with 3 weeks of fever, pale stools, jaundice, and colicky right upper quadrant pain. He had limited access to clean water. Labs revealed leukocytosis (24,870/µL) with neutrophilia and elevated conjugated bilirubin (3.8 mg/dL). Ultrasound identified echogenic tubular structures in the common bile duct, causing intrahepatic and extrahepatic bile-duct dilation. ERCP visualized a live Ascaris lumbricoides worm protruding from the ampulla, followed by the removal of two additional worms using a balloon catheter. Diagnosis: biliary ascariasis with secondary cholangitis. Treatment included albendazole and piperacillin–tazobactam, with symptom resolution within one week.