Ascaris infestation of biliary tree mimicking gallbladder cancer

A 51-year-old male presented with jaundice for 2 months. e had a history of acute pancreatitis 4 months before and eight loss of 20 kg. Laboratory tests demonstrated elevated otal and direct bilirubin (288.6 mol/L and 232.4 mol/L, respecively). CA19-9 was also significantly increased (>1200 U/ml). ltrasound and magnetic resonance imaging both indicated rregular thickening of gallbladder (Fig. 1). Magnetic resonance holangio-pancreatography (MRCP) revealed marked dilatation of ntrahepatic ducts. Therefore, a diagnosis of gallbladder cancer with ilar invasion was made. The patient underwent endoscopic retrograde cholangioancreatography, which suggested the structure of upper part f the common bile duct and hilar bile ducts were abnormal, ith a visible filling defect inside. After sphincterotomy, a long haped object was pulled through the ampulla of Vater with stone