Aim: This study was undertaken to review the predisposing factors, presentation and
management of patients diagnosed with biliary ascariasis while specifically emphasizing the
role played by endoscopy.
Methods: We performed a retrospective analysis of nine patients diagnosed and admitted
with biliary ascariasis at our center. The diagnosis was based on ultrasound findings and
confirmed by detection of round worms in the biliary tract or the descending duodenum. The
clinical presentation and management were reviewed.
Results: Five of the nine patients had prior biliary sphincter ablative/ bypass procedures for
choledocholithiasis; including endoscopic sphincterotomy in four and lateral
choledochoduodenostomy in one patient. All but one patient presented with acute onset
pain abdomen radiating to the back. One patient presented with features of acute cholecystitis.
Ultrasound detected the presence of round worms in all the patients. Endoscopic retrograde
cholangio-pancreatogram confirmed presence of worm in the biliary tree. Endoscopic extraction
of the worm from the biliary tree or duodenum was successfully undertaken in all the patients
and provided prompt relief. One patient had recurrence of infection after eight months which
was re-treated by endoscopic extraction. Antihelminthics were instituted in all patients.
Conclusion: Biliary ascariasis, should be considered in the differential diagnosis of acute
abdomen, particularly in patients who have undergone prior biliary sphincter ablation/ bypass
procedures like sphincterotomy or choledochoduodenostomy. Ultrasonography is a reliable
diagnostic modality. Endoscopic retrograde cholangiogram confirms the diagnosis and
precedes endoscopic extraction of the worm. This offers prompt relief from symptoms.