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Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration

Epublication WebSurg.com, Sep 2016;16(09). URL: http://websurg.com/doi/vd01en4733

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  • 2016-09-05
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This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant. Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass. Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%). Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L. Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct. Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy. In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube. An Ascaris lumbricoides of 25cm in length was extracted. After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.