Introduction:
Acute cholangitis caused by hepatobiliary ascariasis is quite rare. Factors like a prior history of hepatobiliary surgery, pregnancy, and prolonged fasting increase the possibility of developing hepatobiliary ascariasis.
Case presentation:
We present a case of obstructive jaundice and severe acute cholangitis caused by massive hepatobiliary and pancreatic duct ascariasis in a 52-year-old male patient. The diagnosis was made based on clinical presentation, imaging, and other basic investigations. The treatment consisted of conservative medical treatment, without an anti-helminthic drug to avoid the death of the worm inside the bile duct with subsequent complications. Our patient declined surgical treatment and died three days after self-discharge.
Conclusion:

Ascaris lumbricoides is a uncommon cause of acute cholangitis. It should be suspected in cases with typical clinical presentation and imaging evidence suggestive of hepatobiliary ascariasis. Endoscopic treatment is the treatment of choice in addition to anti-helminthic drugs and additional medical support. Conservative treatment alone is less likely to be successful.