Intrahepatic and extrahepatic biliary ascariasis in a pediatric patient. A case report

Background: Biliary ascariasis is an uncommon but serious complication of Ascaris lumbricoides infection, particularly in children living in endemic regions.Case report: We present the case of a previously healthy 9-year-old male patient who was admitted with a two-week history of fever, asthenia, and right upper quadrant abdominal pain. Physical examination revealed abdominal tenderness and hepatomegaly approximately 6 cm below the costal margin. Initial laboratory tests showed marked leukocytosis (30,290/mm³) and a cholestatic pattern on liver function tests. Abdominal ultrasound revealed dilatation of both intrahepatic and extrahepatic bile ducts, along with an image consistent with parasites in the common bile duct (triple-line sign). Antiparasitic treatment was initiated with albendazole 400 mg/day for three days, followed by piperazine 75 mg/kg/day for two days, resulting in massive expulsion of Ascaris worms in the stool. The patient was discharged following favorable clinical and laboratory improvement, with outpatient follow-up arranged. Conclusion: Biliary ascariasis should be considered in children presenting with abdominal pain and abnormal liver function tests in endemic areas. Timely antiparasitic treatment can prevent complications and the need for surgical intervention. Keywords: Biliary ascariasis.