Fig. 10.6 Ascaris in extrahepatic and intrahepatic bile ducts. (A) Adult worms in the markedly dilated common bile duct and biliary radicals. (B) Numerous adult ascarids in the bile ducts and liver. (C) Autopsy specimen showing abscesses involving the liver and diaphragm as a result of migrating adult ascarids. One transected Ascaris protrudes from a bile duct (bottom).

Ascarids may migrate into the biliary and pancreatic ducts (Fig. 10.6). When this happens, ductal obstruction may occur, causing ascending cholangitis, cholecystitis, choledocholithiasis, liver abscess, or hemorrhagic pancreatitis, sometimes terminating fatally (Fig. 10.7).

Fig. 10.7 (A) Adult Ascaris obstructing the pancreatic duct and causing a fatal hemorrhagic pancreatitis. AFIP 70-6814. (Courtesy of Dr. Heriberto Pagan-Saez, Puerto Rico.) (B) Section of an adult Ascaris in the pancreatic duct. AFIP 70-6814-2.