Multiple Organ Failure Secondary to Pancreatitis Due to Biliary Ascariasis in a Young Patient: A Case Report on the Importance of a Good Anamnesis.
- 1Faculty of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras.
- 2Internal Medicine Physician, Hospital Escuela, Tegucigalpa, Honduras.
- 3Faculty of Medical Sciences, Hospital Escuela, National Autonomous University of Honduras, Tegucigalpa, Honduras.
Abstract
Biliary ascariasis is an uncommon trigger of acute abdomen in endemic areas that can lead to severe biliary obstruction and acute pancreatitis. In low-resource settings, self-medication prior to presentation can create diagnostic distractors, confounding the clinical picture with drug-induced liver injury (DILI). A 22-year-old male from rural Honduras presented in refractory shock (BP 60/40 mmHg), hepatic encephalopathy (GCS 6), jaundice, and upper gastrointestinal bleeding following the massive ingestion of analgesics and herbal extracts. Laboratory findings demonstrated severe hepatic dysfunction (AST 12,750 U/L, ALT 13,150 U/L, total bilirubin 6.7 mg/dL, INR 3.53), acute kidney injury (creatinine 5.04 mg/dL), and rhabdomyolysis. Initial supportive management targeted suspected fulminant drug-induced hepatitis. Subsequent targeted anamnesis on day 7 identified a pre-hospital history of severe epigastric pain radiating to the back with antalgic positioning. Re-evaluation of day 3 diagnostics revealed a serum lipase of 905 U/L and abdominal ultrasonography demonstrating tubular, "railway-track" hyperechoic images within the common bile duct, confirming severe acute pancreatitis secondary to biliary ascariasis overlapping with acute DILI. The patient was managed conservatively with hemodynamic support, blood products, and hemodialysis. Spontaneous oral expulsion of Ascaris parasites occurred during the acute phase, with follow-up ultrasonography confirming biliary clearance. Organ function gradually improved, and the patient was discharged with residual organ sequelae requiring outpatient surveillance. Severe acute pancreatitis due to biliary ascariasis can co-exist with or be masked by drug-induced hepatic toxicity. Clinicians in endemic regions must maintain a high index of suspicion for mechanical parasitic obstruction, using systematic anamnesis and pancreatic enzyme evaluation to prevent diagnostic anchoring biases during critical organ failure management.
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BibTeX
@article{cherif2026multiple,
title = {{Multiple Organ Failure Secondary to Pancreatitis Due to Biliary Ascariasis in a Young Patient: A Case Report on the Importance of a Good Anamnesis.}},
author = {Hugo-Malik Cherif and Daniela Ocampo and Belisa Nicolle Espinoza and Alejandra Patricia Paz},
journal = {International medical case reports journal},
year = {2026},
month = oct,
doi = {10.2147/imcrj.s637467},
url = {https://europepmc.org/article/MED/42974163},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Multiple Organ Failure Secondary to Pancreatitis Due to Biliary Ascariasis in a Young Patient: A Case Report on the Importance of a Good Anamnesis.
AU - Hugo-Malik Cherif
AU - Daniela Ocampo
AU - Belisa Nicolle Espinoza
AU - Alejandra Patricia Paz
PY - 2026
DA - 2026/10/29
JO - International medical case reports journal
DO - 10.2147/imcrj.s637467
UR - https://europepmc.org/article/MED/42974163
AB - Biliary ascariasis is an uncommon trigger of acute abdomen in endemic areas that can lead to severe biliary obstruction and acute pancreatitis. In low-resource settings, self-medication prior to presentation can create diagnostic distractors, confounding the clinical picture with drug-induced liver injury (DILI). A 22-year-old male from rural Honduras presented in refractory shock (BP 60/40 mmHg), hepatic encephalopathy (GCS 6), jaundice, and upper gastrointestinal bleeding following the massive ingestion of analgesics and herbal extracts. Laboratory findings demonstrated severe hepatic dysfunction (AST 12,750 U/L, ALT 13,150 U/L, total bilirubin 6.7 mg/dL, INR 3.53), acute kidney injury (creatinine 5.04 mg/dL), and rhabdomyolysis. Initial supportive management targeted suspected fulminant drug-induced hepatitis. Subsequent targeted anamnesis on day 7 identified a pre-hospital history of severe epigastric pain radiating to the back with antalgic positioning. Re-evaluation of day 3 diagnostics revealed a serum lipase of 905 U/L and abdominal ultrasonography demonstrating tubular, "railway-track" hyperechoic images within the common bile duct, confirming severe acute pancreatitis secondary to biliary ascariasis overlapping with acute DILI. The patient was managed conservatively with hemodynamic support, blood products, and hemodialysis. Spontaneous oral expulsion of Ascaris parasites occurred during the acute phase, with follow-up ultrasonography confirming biliary clearance. Organ function gradually improved, and the patient was discharged with residual organ sequelae requiring outpatient surveillance. Severe acute pancreatitis due to biliary ascariasis can co-exist with or be masked by drug-induced hepatic toxicity. Clinicians in endemic regions must maintain a high index of suspicion for mechanical parasitic obstruction, using systematic anamnesis and pancreatic enzyme evaluation to prevent diagnostic anchoring biases during critical organ failure management.
SN - 1179-142X
ER -