Title : Biliary Ascariasis
 
Clinical Problem : A 7 years old boy presented with fever and right hypochondriac abdominal pain for a 1 month. There was no vomiting or jaundice. He underwent an ultrasound {USG} abdomen that showed edematous common bile duct with round worm like linear structure at porta. Stool examination was normal. Liver function tests were normal. Hemogram showed anemia with eosinophilia {absolute eosinophil count = 2560 cells, cumm}. X-Ray abdomen showed air fluid levels.
 
Question : How to treat biliary ascariasis_?
 
Expert Opinion : Ascariasis is the commonest helminthic infection in the world. The adult round worm normally lives in the small intestine. Sometimes they tend to invade the bile or pancreatic ducts. Most patients present with upper abdominal colicky pain. Diagnosis of round worm in common bile duct is established by USG abdomen. Treatment consists of initially conservative therapy with antispasmodics and albendazole {single dose of 400 mg}. Endoscopic or surgical intervention is required when conservative treatment fails. Repeated deworming may be required. Occasionally the worm may die in the bile duct. The presence of a dead worm forms a nidus for stone formation. Intervention is required in those critically sick with pyogenic cholangitis or worms failing to leave the biliary free within four weeks as by that time they are presumed to be dead and need extraction of worms with stone.

In this patient, endoscopic extraction of worm from the bile duct was required as the patient had symptoms for more than 4 weeks.
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2014.31
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