An Uncommon Cause of Cholangitis and Cholecystitis

of the gallbladder wall, lumen filled with echogenic millimetric particles compatible with microlithiasis). Subsequently, endoscopic ultrasound was performed and revealed inflamed (diffuse ductal wall oedema) and dilated common bile duct and cystic duct, both filled by an elongated and rounded structure with a double-tubular core (Fig. 1), and multiple enlarged hilar lymph nodes. According to the diagnosis of cholangitis, an endoscopic retrograde cholangiopancreatography was performed. When reaching the duodenum, a squirming live worm was observed coming out of the papilla (Fig. 2). It was gently grasped using a rat-tooth forceps and pulled out by removing the duodenoscope and forceps together through the mouth (Fig. 3). Cholangiography showed no filling defects. The pathological examination was consistent with a specimen of Ascaris lumbricoides (Fig. 4) and a single dose of albendazole was administered. The patient had a complete clinical and analytical recovery and was discharged with a scheduled delayed laparoscopic cholecystectomy. Ascariasis is the most prevalent helminthic infection in humans, above all in tropical countries with poor socioeconomic conditions. It is acquired through the ingestion of matured ova in contaminated water, raw vegetables, and food [1–3]. Once in the duodenum, eggs hatch and larvae are released, penetrating the mucosa and migrating through