The adventures of ‘Ascaris lumbricoides’ - An intrepid traveller

Abstract

Hepatobiliary ascariasis is an underestimated & unforeseen corollary of gastrointestinal ascariasis particularly common amongst the endemic populations. A high index of suspicion coupled with the increased use of ultrasonography & endoscopic procedures have unravelled this deviant sequel of helminth infestation. Conservative measures with meticulous sonographic surveillance remain the preferred first-line treatment for worms confined to the biliary ducts; with, endoscopic and surgical interventions being reserved for the persistently symptomatic or when complications ensue. Gall bladder ascariasis however mandates aggressive endoscopic/ surgical measures in most cases due to poor inherent response to pharmacotherapy alone. We hereby present the study of a 10 years old female child with the sonographic, MRCP, per-operative & histopathological correlates of hepatobiliary ascariasis. The bizarre eventuality of the worm migrating from the gastrointestinal tract and traversing across the intrahepatic ducts to ultimately lodge within the gall bladder (as demonstrated on consecutive scans & confirmed per-operatively ) , especially across narrow calibre childhood ducts is a singular affair and hence consigns exclusivity to our case.