The presentation.
A patient presented with right-upper-quadrant pain and a clinically evident obstructive picture. Initial ultrasound suggested a linear, mobile filling defect within the common bile duct, a finding that, in Kashmir specifically, raises Ascaris lumbricoides migration into the biliary tree as a leading consideration rather than an exotic one.
The procedure.
Side-viewing ERCP was performed at Shifa Medical Centre. A live ascarid was visualised within the ampulla and retrieved with a Dormia basket under direct fluoroscopic guidance. The duct was cleared in a single session. No sphincterotomy was required.
Why this case is here
Because regional prevalence matters. The same imaging finding that would be exotic elsewhere is a routine diagnostic consideration here, and the procedure that resolves it is one that should be available within a same-day workflow.