Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstruction in a young male who presented with acute cholangitis. The ascaris was removed by laparoscopic exploration of the common bile duct. Postoperative period was uneventful.

Introduction Laparoscopic cholecystectomy is now considered the gold standard for the treatment of symptomatic cholelithiasis. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before surgery using the clinical and ultrasonographic criteria in our set up. Materials and methods A total of 200 patients presenting with symptomatic gall stone disease between January 2011 and June 2012 were included in the study. Every patient included in the study was subjected to the following assessments which were regarded as risk factors for laparoscopic cholecystectomy: patients' characteristics, complaints, history and clinical examination and laboratory data. Results Amongst the 200 patients admitted for laparoscopic cholecystectomy, 47 (23.5%) were male and 153 (76.5%) female, with an average age of 39 years (range 16-62 years).The body mass index ranged from 16.3 to 42.7 with a mean of 32.8 ± 6.28 kg/m 2. Five patients were considered obese (BMI > 35 kg/m 2). Conclusion Male gender, single large stone, thickwalled gallbladder, previous abdominal surgery and contracted gallbladder are the factors that proved to be significant factors in our study.

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Benign biliary strictures fall into two aetiological groups: traumatic

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