Endoscopic ultrasound features of biliary ascariasis

A 36-year-old woman presented with features of acute cholangitis. Ultrasonography showed distended gall bladder and mildly dilated common bile duct (CBD). Endoscopic ultrasound (EUS) [Figure 1] prior to therapeutic ERCP showed the tail of a roundworm jutting out of the ampulla of Vater. In addition there was choledocholithiasis. The worm escaped into the CBD during EUS. ERCP revealed a mild distal biliary stricture necessitating sphincterotomy for successful extraction of the worm and calculi. The patient was also treated with oral albendazole.