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+A 16-year-old female suffered from an abdominal pain at right upper quadrant, lasting for more than 10 days.
+Shortly ahead of her medical consultation, 4 ascaris-like worms were vomited out, individually with a length of about 10 cm.
+She had a previous onset of ascariasis, during which low-grade fever (38.4°C) occurred without apparent jaundice, diarrhea, or anemia.
+Physical examination revealed tenderness at right upper quadrant.
+Her total leukocyte count was 11.2 G/L consisting of 5.2% eosinophils.
+Serum and urine amylase were 386 and 928 U/L, respectively.
+In terms of liver functionality, the level of total bilirubin rose up to 23.2 μm/L, meanwhile the hepatic enzymes were similarly elevated (alanine aminotransferase 163 U/L; aspartate aminotransferase 96 U/L).
+Abdominal ultrasound described the enlargement of the gallbladder, upper segment of common bile duct (1.5 cm in diameter) and intrahepatic bile duct (1.3 cm in diameter).
+Furthermore, the intrahepatic bile duct was also discovered to be filled with echogenic and banded substances.
+Based on such evidences, she was clinically diagnosed as biliary ascariasis with a concomitant manifestation of biliary duct infection.
+Through a laparoscopic exploration, the enlarged gallbladder and common bile duct were visually confirmed, as well as the massive storage of worms within the biliary tract.
+Subsequently, a 1 cm incision was made on the common bile duct in order to facilitate the extraction of the pathogenic worms, which were then placed into a specimen bag laparoscopically (Fig.1).
+Once the contained worms were virtually cleared out under laparoscope, chodedochoscopy was employed to seek for more hidden worms inside the biliary system (Fig.2).
+After finishing the removal of ascarides, the biliary duct incision was well sutured, with a T-tube placed in situ (Fig.3).
+Eventually, a standard laparoscopic cholecystectomy was performed, followed by the removal of specimen bags and drainage tube placement (Fig.4).
+The total amount of worms inside the common bile duct summed up to more than 100 (Fig.5).
+Postoperatively, she was treated with oral antihelminthic drugs for 3 days.
+The T-tube was rinsed with saline every day, and during the first 3 days, 6 more worms were additionally washed out.
+The patient experienced a smooth postoperative recovery and was finally discharged from hospital without any complications.