Endoscopic removal of Ascaris lumbricoides from the biliary tract as emergency treatment for acute suppurative cholangitis

Ascariasis is the most common intestinal helminthiasis worldwide. Heavily i nfected individuals are prone to develop bowel obstruction or perforation a s well as biliary disease. Nevertheless, the presence of roundworms in the biliary tree outside endemic areas is very uncommon. The migration of these worms to the biliary system can cause biliary colic, pancreatitis, or even acute suppurative cholangitis with hepatic abscesses and septicemia. We report here on 2 infants with 14 and 15 months and a 9-year-old boy who suffered from massive biliary ascariasis and who presented with acute suppu rative cholangitis. All cases were successfully treated by endoscopic retro grade cholangiopancreatography with worm extraction and adjuvant medical th erapy. Physicians should be aware of ascariasis in patients with pancreatobiliary symptoms who have traveled to endemic areas or in immigrants from these are as.