Snapshot quiz (October 2021 [1])

Published: 12/09/2021

Authors: A Parikh and S Parikh

a The cholangiogram shows a linear filling defect in the common bile duct (CBD). b Endoscopic sphincterotomy and extraction of dead Ascaris lumbricoides was performed. c Dead worm with small stones in duodenum. In endemic areas, A. lumbricoides are often seen in the duodenum, CBD, gallbladder, and main pancreatic duct. Presenting symptoms include recurrent cholangitis and vomitus containing worms. Movement of worms in and out of the CBD produces pain. Lack of nutrition and concentrated bile within the CBD leads to the death of worms, which leads to formation of pigment stones, cholangitis, and hepatobiliary abscesses. Most patients with hepatobiliary ascariasis require frequent deworming medications.