Background: Ascariasis is a common helminthic disease that affects the gastrointestinal tract of human beings and is caused by the Ascaris lumbricoid worm. Most of the time, this parasite resides in the intestinal lumen, but it can occasionally travel to the biliary tract through the ampulla of Vater. The most serious and potentially fatal complication of intestinal ascariasis is biliary ascariasis, which can appear in different ways. Case Report: A non-diabetic, non-alcoholic female reported to the emergency department with a one-day history of abdominal pain and vomiting with worms. The pain began gradually with a score of 7/10 and rapidly deteriorated during the day, reaching 10/10 at the hospital presentation. The patient also had a significant medical history.  Before papillotomy, she underwent endoscopic retrograde cholangiopancreatography with the removal of one common bile duct (CBD) stone, but no stent was implanted. She had her laparoscopic cholecystectomy done as well. Laboratory examination revealed normal liver function tests and C-reactive protein. While abdominal ultrasound confirmed the presence of hepatic pericholangitis and on ultrasound imaging, the CBD was found to be enlarged approximately 7 mm in diameter and had a linear tubular structure with centre faint echogenicity and periphery tubularity. The ultimate diagnosis of the patient was cholangitis brought on by Ascaris lumbricoides. After the diagnosis, endoscopic retrograde cholangiopancreatography showed sphincterotomy with CBD dilation. The worm was extracted by grasping it with biopsy forceps and pulled out of the papilla using a balloon catheter. The length of the worm was 18 centimeters. Conclusion: Ascaris is the most frequently occurring disease that can cause biliary complications, such as cholangitis.  This case report suggests that cholangitis caused by Ascaris lumbricoides can be successfully treated with the endoscopic approach, indicating that endoscopy could be a viable option to manage ascaris.

Background: Achalasia is a medical ailment characterized by irregular contractions of the esophagus and incomplete relaxation of the lower esophageal sphincter. This condition results in difficulty swallowing food and liquids, and often leads to regurgitation and heartburn. Case presentation: This case report describes a 36-year-old female patient who presented with difficulty swallowing, heartburn, chest pain, and coughing while eating or drinking. The patient had lost significant weight despite a good appetite, and a physical examination revealed poor nutrition. Esophageal manometry confirmed the diagnosis of Achalasia Type 1, and endoscopy showed severe Candida esophagitis and a very dilated esophagus with diverticula. Due to the patient's condition and endoscopic finding of diverticula, surgery was considered, as she did not qualify for the Peroral Endoscopic Myomectomy (POEM) procedure. The patient was treated with fluconazole to address the esophageal candidiasis, and NG feeding was initiated to improve weight and nutrition. After recovering, the patient underwent a laparoscopic Heller myotomy with Dor fundoplication using a video laryngoscope to facilitate intubation. Anesthesia was maintained with O2/air with Sevoflurane, and the patient was extubated and transferred to the post-anesthesia care unit. Conclusion: Achalasia is a frequently researched esophageal motility disorder that is distinguished by inadequate relaxation of the LES and absent or irregular peristalsis in the esophagus. Common symptoms in most patients include difficulty swallowing solids and liquids, regurgitation, and varying degrees of weight loss. This case highlights the importance of prompt diagnosis and treatment of Achalasia Type 1, as well as the use of rapid sequence induction and proper anesthesia techniques during surgery.