What is biliary ascariasis?

Biliary ascariasis is generally a severe complication of ascariasis, caused primarily by the migration of *Ascaris lumbricoides* (roundworms) from the gastrointestinal tract into the biliary system. When intestinal roundworms become highly active, they may migrate upward through the ampulla of Vater into the bile ducts, thereby triggering biliary ascariasis.

What is Biliary Ascariasis?

Patients commonly experience nausea and vomiting. Due to mechanical irritation caused by the worms within the biliary tract, patients typically develop sudden, severe upper abdominal pain. In severe cases, complications such as hepatic abscess and secondary infection may occur.

1. Antispasmodic and Analgesic Medications: Oral magnesium sulfate and antispasmodics may be administered initially to relieve spasm of the sphincter of Oddi and surrounding biliary smooth muscle. For severe pain, intramuscular injection of atropine or propantheline may be used; if inadequate, pethidine may be added for additional analgesia.
2. Anthelmintic Therapy: Deworming should be initiated only after pain has been adequately controlled. Commonly prescribed anthelmintics include piperazine citrate, levamisole, or pyrantel pamoate.
3. Choleretic Agents: Choleretics such as artemisinin A (Artemisia capillaris extract), dehydrocholic acid, or Xiaoyan Lidan tablets may be used to promote bile secretion, facilitating the expulsion of dead or paralyzed worms via bile flow.
4. Antibiotics: Antibiotics—including penicillins or fluoroquinolones—may be administered to control or prevent secondary bacterial infection.

1. During episodes of severe pain, patients should assume a supine position with knees flexed and abdominal muscles relaxed. Gentle but firm pressure applied to the painful area followed by rapid release may help alleviate discomfort.
2. During acute pain, patients may also ingest a small amount of vinegar orally, which may reduce worm motility and thereby ease symptoms.

We hope the above information is helpful. Wishing you good health and happiness!