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Case ReportOpen Access
Endoscopic Retrograde Cholangio-Pancreatographic Diagnosis and Extraction of Massive Biliary Ascariasis Presented with Acute Pancreatitis : A Case Report
Saowaros V 
This paper reports the case of a young female Thai patient who presented with periodic
severe abdominal pains which proved to be acute pancreatitis. Conventional investigations and
treatments failed to prove and improve her condition. ERCP was done on the twelfth day after
admission. 3 caudal ends of living round worms were noted protruding from the papillary orifice
during endoscopy. Cholangiography revealed impacted multiple round worms in the common bile
duct and both intrahepatic ducts. Endoscopic extraction of the worms was done by using dormia
basket and removed with endoscope. Repeated procedure was done 21 times in two and a half
hours, obtaining 26 live, mature Ascaris lumbricoides varying from 13 to 24 em in length. Repeated
cholangiogram confirmed complete removal of the worms. The patient was relieved from abdominal
pain immediately after the procedure, and given oral albendazole 400 mg daily for 7 days.
She was discharged asymptomatic 8 days after Ascaris removal.
Key word : ERCP, Massive Biliary Ascariasis, Acute Pancreatitis. Endoscopic Extraction
severe abdominal pains which proved to be acute pancreatitis. Conventional investigations and
treatments failed to prove and improve her condition. ERCP was done on the twelfth day after
admission. 3 caudal ends of living round worms were noted protruding from the papillary orifice
during endoscopy. Cholangiography revealed impacted multiple round worms in the common bile
duct and both intrahepatic ducts. Endoscopic extraction of the worms was done by using dormia
basket and removed with endoscope. Repeated procedure was done 21 times in two and a half
hours, obtaining 26 live, mature Ascaris lumbricoides varying from 13 to 24 em in length. Repeated
cholangiogram confirmed complete removal of the worms. The patient was relieved from abdominal
pain immediately after the procedure, and given oral albendazole 400 mg daily for 7 days.
She was discharged asymptomatic 8 days after Ascaris removal.
Key word : ERCP, Massive Biliary Ascariasis, Acute Pancreatitis. Endoscopic Extraction
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