Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis,
cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver abscesses. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris through a surgical choledochotomy and
subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure.
A 55-year-old woman with interminttent colickyright upper quadrant abdominal pain was admitted to our hospital. Abdominal sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with
acoustic
shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by
sphincterotomy
and
lithotripsy then we directly extracted ascaris with tripod forced without any complication.
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