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<p>A lady in her late 40&#xa0;s presented with recurrent right hypochondrial pain and low-grade fever for 4&#xa0;months. She had a history of Roux-en-Y hepaticojejunostomy for a choledochal cyst in her childhood. Her laboratory investigations revealed elevated liver enzymes, while magnetic resonance cholangiopancreatography (MRCP) suggested a stricture at the hepaticojejunostomy. The initial attempt at percutaneous balloon dilatation failed. The patient underwent exploratory laparotomy, and an enterotomy was made, which revealed a dead <i>Ascaris lumbricoides</i> obstructing the hepaticojejunostomy anastomosis. The intact parasite was successfully removed, and the enterotomy was repaired. The patient recovered well postoperatively. Biliary ascariasis is a rare but important differential in endemic regions, particularly in patients with altered biliary anatomy. Ultrasonography and MRCP aid diagnosis, though distinguishing parasitic obstruction from strictures can be challenging. When percutaneous approaches fail, surgical exploration remains the definitive management for the removal of ascariasis.</p>

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Biliary Ascariasis Presenting as Hepaticojejunostomy Stricture: A Case Report

  • 期刊论文

  • 发表日期：

    2025年7月21日

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  • Sriparna Biswas,
  • Bijit Saha,
  • Rohith Kodali

摘要

A lady in her late 40 s presented with recurrent right hypochondrial pain and low-grade fever for 4 months. She had a history of Roux-en-Y hepaticojejunostomy for a choledochal cyst in her childhood. Her laboratory investigations revealed elevated liver enzymes, while magnetic resonance cholangiopancreatography (MRCP) suggested a stricture at the hepaticojejunostomy. The initial attempt at percutaneous balloon dilatation failed. The patient underwent exploratory laparotomy, and an enterotomy was made, which revealed a dead Ascaris lumbricoides obstructing the hepaticojejunostomy anastomosis. The intact parasite was successfully removed, and the enterotomy was repaired. The patient recovered well postoperatively. Biliary ascariasis is a rare but important differential in endemic regions, particularly in patients with altered biliary anatomy. Ultrasonography and MRCP aid diagnosis, though distinguishing parasitic obstruction from strictures can be challenging. When percutaneous approaches fail, surgical exploration remains the definitive management for the removal of ascariasis.