Biliary ascariasis

The round worm,  Ascaris lumbricoides, commonly infests the intestine of inhabitants of Asia, Africa and Central America. It may enter the biliary tree through the ampulla of Vater and cause biliary pain. Complications include strictures, suppurative cholangitis, liver abscesses and empyema of the gall bladder. In the uncomplicated case, antispasmodics can be given to relax the sphincter of Oddi and the worm will return to the small intestine to be dealt  with by antihelminthic drugs. Operation may be necessary to remove the worm or deal with complications. Worms can be extracted via the ampulla of Vater by ERCP. Extraction of a stone from the common bile duct by the Burhenne technique. (a) A T-tube  in situ  with a stone in the duct. (b) A steerable catheter has been manipulated into the duct and a  basket placed around the stone. (c) The stone being extracted from the bile duct along the T-tube track.