Unveiling the rare: biliary tract ascariasis complicated by liver abscess and haemothorax

Ascariasis, caused by Ascaris lumbricoides, is a common parasitic infection in developing countries, whereas biliary ascariasis is an uncommon manifestation that may present as cholangitis, biliary obstruction, or cholecystitis. We report the first documented case of biliary ascariasis in a 43-year-old Saudi man presenting with right upper quadrant pain and initially diagnosed with acute cholecystitis. Imaging revealed tubular filling defects within the biliary tree consistent with ascariasis, complicated by a liver abscess. The patient was treated with albendazole, followed by percutaneous drainage using a pigtail catheter and endoscopic retrograde cholangiopancreatography for worm extraction. Management was complicated by a haemothorax secondary to pigtail catheter insertion, requiring thoracic surgical intervention. The patient recovered successfully following multidisciplinary management. This case highlights the diagnostic challenges of biliary ascariasis in non-endemic settings, its potential for severe complications, and the importance of coordinated multidisciplinary care in achieving favorable outcomes.