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Therefore, we reported the case of a 68-year-old Thai man who presented with acute fever, intense right upper quadrant abdominal pain and jaundice for 2 days. His medical history was normal except for the history of intermittent biliary colic for a year. Endoscopic retrograde cholangiography was performed and demonstrated multiple, creamy-coloured roundworms coming out from the ampulla of Vater as well as a tubular filling defect in dilated common bile duct from cholangiography. He was diagnosed with acute cholangitis by biliary ascariasis and underwent endoscopic parasitic removal, which subsequently improved symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2020-239784","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T12:50:27Z","timestamp":1616590227000},"page":"e239784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Massive biliary ascariasis: an unusual cause of acute cholangitis"],"prefix":"10.1136","volume":"14","author":[{"given":"Natthapat","family":"Rujeerapaiboon","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-5977","authenticated-orcid":false,"given":"Apichat","family":"Kaewdech","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,24]]},"reference":[{"key":"2025082711140863000_14.3.e239784.1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3748\/wjg.v8.i1.150","article-title":"Early diagnosis and treatment of severe acute cholangitis","volume":"8","author":"Zhang","year":"2002","journal-title":"World J Gastroenterol"},{"key":"2025082711140863000_14.3.e239784.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4291\/wjgp.v9.i1.1","article-title":"Acute cholangitis - an update","volume":"9","author":"Ahmed","year":"2018","journal-title":"World J Gastrointest Pathophysiol"},{"key":"2025082711140863000_14.3.e239784.3","first-page":"S415","article-title":"Prevalence of parasitic infections among Thai patients at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand","volume":"85 Suppl 1","author":"Nuchprayoon","year":"2002","journal-title":"J Med Assoc Thai"},{"key":"2025082711140863000_14.3.e239784.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68653-4"},{"key":"2025082711140863000_14.3.e239784.5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0016-5085(85)90501-3","article-title":"Biliary ascariasis. 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