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A case of haemobilia following biliary ascariasis is presented. Angiography confirmed an aneurysm of the left hepatic artery, which was successfully embolised. The patient made an uneventful recovery.

Intestinal ultrasound, a frequently applied diagnostic tool in industrialized nations, has recently also been introduced in tropical regions. This study attempts to describe the anatomical and sonographical features of Ascaris lumbricoides in the human intestine. In the course of a schistosomiasis morbidity study in Madagascar, 581 inhabitants of a rice-farming village on the high plateau of the island had their stools examined by means of a modified Kato-Katz thick smear technique (four slides per sample); 53% had eggs of Ascaris lumbricoides in their stools. Twenty-two individuals underwent intestinal ultrasound examination and, in six cases, Ascaris lumbricoides was visualized. All six patients showed eggs upon stool examination. At ultrasound, the parasite was seen as a large, curved echogenic strip (4-6 mm in diameter) with an inner, anechoic, longitudinal canal. The image resembled a winding highway, the central structure representing the pseudocoel of the parasite. Patients were treated with mebendazole. The excreted worms of one patient were scanned under water, showing the same characteristics as in vivo. We conclude that Ascaris lumbricoides has a characteristic sonographical appearance and should not be a confounding factor in studies using intestinal ultrasound.

Ascaris lumbricoides is the most common roundworm in warm and temperate areas. Although radiological features of Ascaris lumbricoides are well defined, there are only a few reports on the ultrasonographic findings of intestinal ascariasis. In our two patients with no acute abdominal symptoms, intestinal ascariasis was initially diagnosed by abdominal ultrasonography. In both patients, tubular structures in the segments of the small intestine were demonstrated by ultrasonography.

Endoscopic retrograde cholangiopancreaticographic features of ascariasis involving the biliary system (56) and pancreatic duct (4) in 60 consecutive patients have been analyzed and their various radiologic appearances described. Ascaris not only presents as a smooth linear filling defect, as commonly described in the literature, but also in a variety of other shapes like parallel smooth filling defects, curves, and loops crossing the hepatic ducts transversely. They can also cause dilatation of the ducts that, depending upon their number and duration of stay, is statistically significant and reversible. Ascaris can also invade the pancreatic duct causing chronic pancreatitis.

A case with association of congenital cystic dilatation of the common bile duct and congenital diverticulum of the hepatic duct is reported. The etiology and classification are briefly discussed and a radiological approach is recommended.

The radiographic findings and complications of Ascaris lumbricoides infection of the gastrointestinal tract are presented. Since the clinical symptoms of ascariasis are usually vague or nonspecific, the radiologist may be in a position to play a major role in the proper diagnosis of this disease.

Roundworm infection rarely causes common bile duct perforation. This complication was demonstrated by intravenous cholangiography in a sixteen month old girl.