Ascaris lumbricoides is a soil-based helminth parasite. It is distributed worldwide, with a high incidence in tropical regions, including those of Colombia and Mexico. Infection with the parasite is considered a neglected tropical disease. Diagnosis is made through microscopic observation of the parasite’s eggs or macroscopic identification of the parasitic worm, such as during endoscopy. A 56-year-old woman, with a past history of cholecystectomy, arrived at the emergency department with diffuse colicky abdominal pain, located in the right hypochondrium, and choluria, for the past 24 h. She also presented with generalized jaundice, leukocytosis, direct hyperbilirubinemia, and elevated transaminase and alkaline phosphatase levels. Magnetic resonance cholangiopancreatography (MRCP) showed the absence of the gallbladder, a metallic clip in the cystic duct, choledocholithiasis, and dilatations of the intrahepatic and extrahepatic bile ducts of 15 and 13 mm, respectively (Fig. 1). Cholangitis was initially considered, and ampicillin-sulbactam was started. A scheduled endoscopic retrograde cholangiopancreatography (ERCP) revealed extrahepatic dilatation and a 12 × 15 mm stone in the common bile duct. Lithotripsy was performed, and an adult Ascaris lumbricoides was discovered and extracted (Video 1 and Fig. 2A and B). Treatment with a single dose of 400 mg of albendazole was indicated. After clinical improvement, the patient was discharged to her home. She had no recurrence during follow-up. Treatment options include albendazole, ivermectin, and nitazoxanide, and in some cases, endoscopic extraction.

Figure 1.

Magnetic resonance cholangiopancreatography (MRCP). The gallbladder is not visualized. There is evidence of choledocholithiasis, with a 13 mm dilatation of the common bile duct and a 15 mm dilatation of the common hepatic duct.

Figure 2.

Endoscopic retrograde cholangiopancreatography (ERCP) images. A) Ascaris lumbricoides is seen protruding from inside the bile duct. B) The worm is shown outside of the bile duct, located in the duodenum, post-extraction.