The patient was transferred to a tertiary pediatric referral centre, and the infectious diseases and gastroenterology teams Figure 1: Supine frontal abdominal radiograph of a 5-year-old boy with biliary ascariasis, obtained at time of patient presentation. [...] On the pre- sumption that these worms would continue to exit the biliary Discussion system and enter the gastrointestinal tract, where they would be amenable to treatment with mebendazole, the course was Ascariasis is a parasitic infection of the intestine caused by Ascaris extended an additional 3 days. [...] After 6 days of treatment, repeat lumbricoides, a helminthic nematode that can grow up to abdominal ultrasonography showed clearance of Ascaris from 25–35 cm in length.2 Infection spreads by fecal oral transmission the biliary system with some residual mild dilatation of the bile and is common, affecting 800 million to 1.2 billion people ducts. [...] Diagnosis is typ- Hepatic abscess also typically presents with fever, hepatomegaly ically made by abdominal ultrasonography, which can suggest and abdominal pain in the right upper quadrant.4 Imaging may be the presence of Ascaris in the biliary tree, and by the presence of needed to distinguish these 2 diagnoses. [...] or Ascaris in the gallbladder, or for whom endoscopic therapy Affiliations: Division of Pediatric Infectious Diseases (Canes); has failed.4,6 Division of General Pediatrics (Seaton, Kang); Department of Radiology (Mawson); Department of Pathology and Laboratory Medicine (Goldfarb), University of British Columbia and BC Chil- Caring for Kids New to Canada dren’s Hospital, Vancouver, BC Contributors.
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