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Multiple Organ Failure Secondary to Pancreatitis Due to Biliary Ascariasis in a Young Patient: A Case Report on the Importance of a Good Anamnesis

Year: 2026

Type: article

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.

Source: International Medical Case Reports Journal

DOI: 10.2147/imcrj.s637467

Authors: Hugo-Malik Cherif, Daniela Ocampo, Belisa Nicolle Espinoza, Alejandra Patricia Paz

Institutions: National Autonomous University of Honduras, Hospital Escuela Universitario

Language: English

Topic: Pancreatitis Pathology and Treatment

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,320