Gallbladder ascariasis complicated by chronic eosinophilic cholecystitis in a one-year-old infant: A case report

Ascaris lumbricoides is one of the most prevalent soil-transmitted helminths, affecting up to 1.2 billion people worldwide. Although it mainly inhabits the intestine, migration to the biliary system can occur. Gallbladder involvement is exceptionally rare, particularly in children.

We report a one-year-old male with recurrent fever, anorexia, vomiting, and weight loss for three months. Past history included neonatal intensive care for hypoplastic lungs, anemia, and sepsis. Examination revealed mild epigastric and right hypochondrial tenderness. Laboratory results showed eosinophilia, and stool analysis confirmed Ascaris ova. Abdominal ultrasound demonstrated hepatomegaly, gallbladder wall thickening, and a hyperechoic mobile lesion suggestive of Ascaris.

Gallbladder ascariasis is extremely uncommon in infants, with only two previously reported cases under one year of age, which were managed conservatively. Clinical features are nonspecific, overlapping with other gastrointestinal disorders. Ultrasound is the diagnostic tool of choice, revealing typical hyperechoic intraluminal structures. In this case, laparoscopic cholecystectomy confirmed a degenerated worm with chronic eosinophilic cholecystitis. While conservative management with anthelmintics is standard, surgery is indicated for complications such as cholecystitis or worm impaction.

Although uncommon, Ascaris lumbricoides may migrate into the gallbladder, resulting in symptomatic cholecystitis. In endemic regions, gallbladder ascariasis should be considered in the differential diagnosis of patients with unexplained gastrointestinal or biliary symptoms. Early recognition through a high index of suspicion and timely ultrasonographic evaluation is essential for accurate diagnosis and optimal management. Peripheral eosinophilia, reflecting the host immune response to parasitic infestation, may provide an additional diagnostic clue.