Common bile duct worm induced pancreatitis: a rare case report from an urban area

Ascaris is the most common intestinal helminth to infest humans in the world. In India, it is endemic to Kashmir and rarely occurs in an urban setting. It has a varied presentation including pancreatitis. Here, we present a case report of a female patient suffering from pancreatitis induced by common bile duct ascariasis in a non-endemic urban area. A 56 year old lady presented with pain upper abdomen and nausea with tenderness in her epigastrium. Contrast enhanced computed tomography was suggestive of pancreatitis. Patient then vomited a worm and further similar history of worm emesis and passage in faeces was elicited. Magnetic resonance cholangiopancreatography showed linear filling defect in distal CBD. 5 live worms were removed via endoscopic retrograde cholangiopancreatography. Vermifuge was started and her follow-up was uneventful. Therefore, there should be a strong suspicion in patients presenting with pancreatitis having a past history or family history of passage of worms in vomits or faeces, even in non-endemic areas.