Intrabiliary Ascariasis in a 12 year old child: a case report of an uncommon cause of acute abdomen and obstructive jaundice in children

Abstract Background: Intrabiliary ascariasis is an uncommon cause of biliary colic and obstructive jaundice among children due to the small size of the ampullary orifice. A high index of suspicion for patients living in an endemic area and radiologic examination are crucial for diagnosis and treatment. Case presentation: a 12 year old male Ethiopian child presented with colicky right upper quadrant pain, nausea, and vomiting of 3 days. Physical examination showed slightly icteric sclera and slightly tender hepatomegaly. Laboratory and ultrasound examinations were suggestive of obstructive jaundice secondary to intra-biliary ascariasis. The child was admitted and followed with conservative management including maintenance fluid, nil per mouth, and analgesics. The abdominal pain and icterus resolved on his second and third day of admission respectively. Follow-up ultrasound showed the worm had migrated out of the common bile duct. The patient was dewormed with a single dose of oral Albendazole 400mg and discharged home. Currently, the patient is well and attending school. Conclusion: Although biliary ascariasis is an uncommon cause of acute abdomen and obstructive jaundice, it should be suspected among patients from endemic areas presenting with suggestive clinical and laboratory features. Conservative treatment is the treatment of choice for uncomplicated biliary ascariasis patients.