Helminthic invasion of the gallbladder: A rare presentation of Ascariasis-induced cholecystitis — A case report.

Abstract

Ascariasis is a prevalent parasitic disease in tropical regions, but migration of Ascaris lumbricoides into the gallbladder is an exceptionally rare occurrence due to the anatomical narrowness of the cystic duct. Recognizing such unusual presentations is vital in endemic regions, particularly in patients presenting with symptoms of acalculous cholecystitis. A 38-year-old female presented with right upper quadrant pain and low-grade fever. Ultrasonography revealed a mobile echogenic structure within the gallbladder, suggestive of Ascaris lumbricoides . Despite empirical antibiotics, persistent symptoms necessitated laparoscopic cholecystectomy. A dead Ascaris worm measuring 13.5 cm was recovered intraoperatively. Postoperative recovery was uneventful, and the patient was prescribed albendazole to prevent reinfection. Although Ascaris typically resides in the jejunum, migration to the biliary tract can lead to cholecystitis, cholangitis, or pancreatitis. Diagnosis is primarily made via ultrasound. Conservative management is first-line; however, surgical intervention is warranted in cases of persistent symptoms or complications. Eosinophilia may be absent in localized or chronic cases, as seen here. Gallbladder ascariasis, though rare, should be included in the differential diagnosis of cholecystitis in endemic areas. Timely imaging and appropriate management—whether conservative or surgical—are essential to prevent complications and ensure recovery.