Rare cause of biliary obstruction by ascariasis associated with choledocholithiasis.

Ascariasis, the most common parasitic infestation of the gastrointestinal tract, is typical of tropical and subtropical countries. Migration of the worm to the bile ducts is rare and has been exceptionally observed in developed countries. This study reports a case of biliary ascariasis associated with gallbladder and common bile duct lithiasis observed in Italy in a 60-year-old woman originating from Senegal. The patient was treated with endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy, and antihelminthic therapy. In particular, ERCP allowed the diagnosis and the extraction of the parasite from the papilla of Vater. After a 6-month follow-up, the patient is in good condition, without signs of cholestasis in laboratory values and no dilatation of the biliary tree at abdominal ultrasound. Although biliary ascariasis is rare in Western countries, the increase in population migration makes it necessary for clinicians world-wide to consider this difficult diagnosis and to determine how to treat it in the most conservative way.

Blind pouch syndrome secondary to gastrojejunostomy. Report of a case.

A case of blind pouch syndrome following a Roux-en-Y reconstruction after gastrectomy is presented. The patient had a history of pain, anaemia and weight loss and the diagnosis was made on the basis of upper gastrointestinal barium contrast radiography. The surgical procedure was an entero-entero anastomosis between the blind loop and the efferent loop. The postoperative course was uneventful. No symptomatic recurrence was found at one-year follow-up. We advocate this procedure as a valid alternative to resection in cases where the blind loop is not damaged by chronic dilatation. The aim of this operation is to maintain the preferential gastric emptying route via the blind loop in order to prevent recurrence on the stump, and reduce loop isolation in order to minimise ischemic or stenotic damage to the anastomosis.