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.