Biliary ascariasis

Case contributed by Dr Ahmed Abdrabou

Presentation

Recurrent attacks of jaundice, itching and pale stool of 3 months duration.

Patient Data

Age: 65 years
Gender: Male
CT

Dilated intrahepatic biliary radicals. The CBD is dilated harboring an elongated hyperdense structure with central hypodensity. The pancreas is seen encircling a duodenal diverticulum filled with air as an accidental finding with bifurcation of the pancreatic duct around it.

Annotated image

The red arrows refer to the worm which is a longitudinal hyperdense structure with central hypodensity.

The white arrows refer to the pancreatic duct which divides to surround an air filled duodenal diverticulum.

Case Discussion

Ascariasis is the commonest helminthic infection worldwide.

CBD infestation results in biliary obstruction and recurrent cholangitis.

ERCP was done for this patient and a dead fragmented worm was extracted.

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Case information

rID: 32463
Published: 27th Nov 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included