Biliary Ascariasis: An Unusual Case of Obstructive Jaundice复制标题

胆道蛔虫症: 一例罕见的阻塞性黄疸

30-year-old woman presented with fever and abdominal pain for 5 days. Physical examination revealed tenderness in the epigastrium and right hypochondrium. Laboratory tests showed deranged liver function tests with an obstructive picture (bilirubin of 65 mmol/L). Magnetic resonance cholangiopancreatography demonstrated linear hypointense filling defects in the common bile duct, suspicious for biliary ascariasis Q4 (Figure 1A and B). Endoscopic retrograde cholangiopancreatography confirmed the diagnosis when worms were discovered within the stomach and duodenum and in the common bile duct (Figure 1C and D). Endoscopic sphincterotomy was performed to facilitate extraction of the worms from the biliary tree. Medical anthelmintic therapy was then commenced. In biliary Q5 ascariasis, anthelmintic therapy should only be initiated after all the worms have been manually removed from the biliary tree, as worms’ carcasses trapped inside may lead to obstruction.

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