AUTHOR(S)
Javier Ara Peche, María Eugenia Quiñonez, and Clara Esquivel

ABSTRACT
Parasites have coexisted with humans throughout history. Ascaris lumbricoides is the most common helminth in the gastrointestinal tract. Although adult worms are usually found in the jejunum, they can migrate to the bile and pancreatic ducts, causing biliary obstruction, cholangitis, pancreatitis, or liver abscesses. Only about 0.45% of infected adults develop this complicated form, and it is more common in women, possibly due to hormonal influence on the biliary smooth muscle. We present the case of a 24-year-old female patient with pain in the right upper quadrant, specifically in the right hypochondrium. At the Hospital de San Benito, Petén, ultrasound showed vesicular dilatation and an obstructive pattern. ERCP revealed multiple ascarids in the stomach, duodenum, and bile duct. After antihelminthic treatment, cholecystectomy was performed without complications.  This clinical case provides novel information by describing a rare presentation of biliary ascariasis in a postpartum patient, a condition rarely reported in the literature. It also highlights the possible role of hormonal changes in the migration of the parasite to the bile duct, underscoring the importance of considering parasitic causes in the differential diagnosis of cholangitis in endemic regions in order to optimize the diagnostic and therapeutic approach.

DOI
https://doi.org/10.59016/avaghj.19432