Sludge or serpent? Unmasking hepatobiliary ascariasis in a young adult female

Ahmed Alam Quadri; Anaya Jawad; Gazala Khan; Mohammed Abdul Muhaimin Ali; Khadijah Amatul Noor Quadri; Zabreen Fatima Sikunder Ali; Syed Ali Raza Abidi; Afreen Quadri; Faizan Rasheed

doi:10.18203/2320-6012.ijrms20251666

Authors

Ahmed Alam Quadri Department of Medicine, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India
Anaya Jawad Department of Medicine, Dr. V. R. K. Women’s Medical College, Aziznagar, Telangana, India
Gazala Khan Department of Medicine, Dr. V. R. K. Women’s Medical College, Aziznagar, Telangana, India
Mohammed Abdul Muhaimin Ali Department Of Medicine, Osmania Medical College, Hyderabad, Telangana, India
Khadijah Amatul Noor Quadri Department of Medicine, Dr. V. R. K. Women’s Medical College, Aziznagar, Telangana, India
Zabreen Fatima Sikunder Ali
Syed Ali Raza Abidi Department of Medicine, Allama Iqbal Teaching Hospital, Dera Gazi Khan, Pakistan
Afreen Quadri Department of Medicine, Dr. V. R. K. Women’s Medical College, Aziznagar, Telangana, India
Faizan Rasheed Department of Medicine, Allama Iqbal Teaching Hospital, Dera Gazi Khan, Pakistan

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251666

Keywords:

Ascariasis, Biliary sludge, Cholecystitis, Parasite, Hepatobiliary

Abstract

Hepatobiliary ascariasis (HBA) is an uncommon but significant cause of biliary obstruction, particularly in regions where Ascaris lumbricoides is endemic. We report a case involving a 21-year-old female who presented with severe epigastric pain and vomiting. Initial evaluation indicated biliary sludge and possible pancreatitis, but her symptoms worsened despite conservative management. Repeat ultrasonography revealed a coiled echogenic structure in the right hepatic and common bile ducts, raising suspicion for parasitic infestation. Magnetic resonance cholangiopancreatography (MRCP) confirmed a tubular filling defect, and endoscopic retrograde cholangiopancreatography (ERCP) enabled extraction of a live Ascaris worm. The patient was treated with albendazole and scheduled for elective cholecystectomy due to persistent gallbladder sludge. This case highlights the importance of considering parasitic infections in the differential diagnosis of biliary symptoms in endemic regions. Early imaging and prompt endoscopic intervention are crucial to prevent complications. Preventive strategies, including improved sanitation, health education, and regular deworming, are essential to reduce the burden and recurrence of ascariasis.

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