An unusual finding: Biliary ascariasis in a pregnant patient managed conservatively—a case report

INTRODUCTION AND IMPORTANCE: Biliary ascariasis, caused by Ascaris lumbricoides, is a rare condition, especially in non-endemic areas. However, it can present with complications such as biliary obstruction, requiring prompt diagnosis and management. This case report highlights the incidental detection and successful management of biliary ascariasis in a pregnant patient. CASE PRESENTATION: A 26-year-old primigravida woman at 24 weeks gestation presented with mild icterus, anorexia, and gastrointestinal symptoms. Laboratory tests showed elevated bilirubin levels and peripheral eosinophilia. Abdominal ultrasound revealed the presence of roundworms in the gallbladder and common bile duct. The patient was managed conservatively with an anti-helminthic agent, resulting in the passing of a dead worm and the resolution of symptoms. CLINICAL DISCUSSION: Biliary ascariasis is a rare condition in non-endemic areas but should be considered in pregnant patients presenting with biliary symptoms. Prompt diagnosis is crucial, and imaging modalities such as abdominal ultrasound play a vital role. Conservative management with appropriate anti-helminthic therapy can effectively resolve symptoms and eliminate the infection. CONCLUSION: This case report emphasizes the importance of considering biliary ascariasis in pregnant patients with biliary symptoms. Timely diagnosis, utilizing imaging modalities, and initiating conservative management with anti-helminthic therapy can lead to successful treatment outcomes. Increased awareness and understanding of this condition can aid clinicians in providing optimal care to similar patients.