Rare cause of biliary obstruction by ascariasis associated with choledocholithiasis

Ascariasis, the most common parasitic infestation of the gastrointestinal tract, is typical of tropical and subtropical countries. Migration of the worm to the bile ducts is rare and has been exceptionally observed in developed countries. This study reports a case of biliary ascariasis associated with gallbladder and common bile duct lithiasis observed in Italy in a 60-year-old woman originating from Senegal. The patient was treated with endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy, and antihelminthic therapy. In particular, ERCP allowed the diagnosis and the extraction of the parasite from the papilla of Vater. After a 6-month follow-up, the patient is in good condition, without signs of cholestasis in laboratory values and no dilatation of the biliary tree at abdominal ultrasound. Although biliary ascariasis is rare in Western countries, the increase in population migration makes it necessary for clinicians world-wide to consider this difficult diagnosis and to determine how to treat it in the most conservative way.