Bile-pancreatic Ascaris lumbricoides infestation - Endoscopic discovery and removal

Ascaris Lumbricoides infestation is relatively rare in industrialized count ries, and it occurs mainly in conditions in which hygiene is larking. We de scribe here a case of a 39-year-old female from ex-Jugoslavia affected by r ecurrent hepatic colic. At entry ultrasonography revealed microlithiasis in the gallbladder and widening of the pancreatic head. The subsequent ERCP s howed slight filling defects in the choledochus and an inflammation-like st ricture of the papilla of Vater, and after endoscopic sphincterotomy we saw an outflow of dense bile and microlitholits. Thus, a standard surgical cho lecystectomy was carried out and the patient was dismissed on the 3rd posto perative day without any symptoms, However, the patient was admitted again after four days for a new coliky pain attach, An upper endoscopy showed a 2 3 cm long mobile parasite in the duodenum: it was caught with the polypecto my loap, extracted and identified as A. Lumbricoides. The patient's symptom s disappeared after the endoscopic removal of the worm and she was dismisse d the day after the worm's removal, No recurrence of symptoms was noted dur ing a 1-year follow-up. This case showed that A, Lumbricoides infestation o f the biliary tree should be considered when biliary and/or pancreatic symp toms recur, especially in patients coming from undeveloped countries. At th e same time me showed that endoscopic removal is a safe and effective treat ment for this Infestation.