[Massive ascariasis of the bile ducts and posterior relapse]

A 7 year old girl presented with persistent right upper abdominal colicky pain, fever, elevated white blood cells count, high blood sedimentation rate and mild liver enlargement. At surgical exploration 33 live ascarides (ascaris lumbricoides) were taken off from the hepatic duct. Medical treatment with mebendazole was given in full doses after surgery. She remained well for six years except for intermittent episodes of colicky right upper abdominal pain. At age 13 year ascarides were again demonstrated at the common biliary duct by abdominal echography. A second operation was necessary to eliminate parasites from the lower biliary tree, together with medical treatment for the patient and her family. One year later she was free of symptoms.