Biliary ascariasis leading to choledocholithiasis, cholangitis, hepatic abscesses and gram negative septicemia

Abstract

Ascariasis is one of the commonest parasitic infections in Asia. In most cases it is asymptomatic, however, rarely it may present with acute abdominal symptoms. We present a case of a South Asian male, who presented with acute obstructive ascending cholangitis due to invasion of the biliary tree by Ascaris lumbricoides, resulting in choledocholithiasis, gram negative septicemia and multiple hepatic abscesses. Biliary invasion by the worms was diagnosed on endoscopic retrograde cholangiopancreatography (ERCP). Common bile duct (CBD) was stented while hepatic abscesses were treated conservatively with antibiotics. The patient did not require surgical intervention.