An Unusual Cause of Biliary Colic.

To cite: Balasubramanian G. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204200 DESCRIPTION A 40-year-old woman presented with postprandial abdominal pain in the epigastric region for 4 days. In the past 6 months, she had intermittent abdominal pain in spite of 6 weeks of proton pump therapy and weight loss of 10 kg. She denied any history of melena, haematochezia, fever, jaundice, vomiting or diarrhoea. Her physical examination was unremarkable. Laboratory studies revealed mild leucocytosis (11 540/mm), normal heamoglobin level, normal pancreatic enzymes, mild transaminitis (aspartate transaminase: 82 IU (normal range: 30–40 IU/dL) and alanine transaminase: 94 IU (normal range: 30–40 IU/dL)) and normal iron studies. She underwent upper endoscopy in view of her dyspeptic symptoms and weight loss. Upper endoscopy revealed ascaris lumbricoides (B) emerging from the major duodenal papilla (A) (figure 1). Following endoscopic extraction of the worm, the patient had clinical recovery with oral albendazole. During follow-up, her liver enzymes and biliary imaging were normal. Learning points