A Doctor’s Encounter with an Ascaris During a Colonoscopy: An Undoubtedly Memorable Experience

As a medical professional, one of the most fascinating parts of my job is the unexpected. During routine procedures, it is not uncommon to encounter unique and unforeseen situations. Last week, my experience as part of a team preparing a patient for an Endoscopic Retrograde Cholangiopancreatography (ERCP) turned into a sight that I have never forget.

Context: The ERCP and Colonoscopy Journey

During a typically routine ERCP on a patient with suspected biliary duct obstruction, I found myself wandering through a familiar yet detailed landscape: the biliary tree. ERCP is a valuable diagnostic and therapeutic procedure that involves placing a flexible endoscope through the patient's mouth, down the esophagus, stomach, and the first part of the small intestine, the duodenum, to reach the ampulla of Vater. This chosen path allows the physician to diagnose, treat, and sample the bile ducts and the pancreas.

The Unexpected: An Ascaris Emerges

While assisting with the ERCP procedure, we were carefully cleansing the bile ducts, a meticulous process that involves flushing the ducts with a solution to remove any bile or debris that may be obstructing them. Our primary goal was to make sure the bile ducts were clear before any necessary interventions such as stenting or stone extraction.

during this process, a remarkable moment occurred when something unexpected happened. As the sphincter of Oddi (the sphincter that controls the release of bile and pancreatic enzymes into the duodenum) was slightly opened, a live ascaris, a species of parasitic nematode commonly known as the roundworm, emerged and wiggled out into the field of view. It was an immediate and sudden event that caught everyone's attention.

A Frozen Moment in Time

The moment was a mix of astonishment, amusement, and a bit of training instinct. The ascaris, with its characteristic slender body and ability to move in a wiggling motion, was clearly visible on the monitor. Everyone except the patient, who was under anesthesia and thus unaware of the spectacle, couldn't help but chuckle at the sight. The camera's flash caught a moment frozen in time, which we quickly documented to comply with our medical protocols for record-keeping.

Reactions and Reflections

It's been a couple of days since the event, and reflecting on it, I find myself both grateful for the experience and appreciative of laughter in tense situations. The insertion of humor can lighten the mood and make even the most routine procedures a bit more memorable.

For the patient, however, the ascaris was nothing but a figment of imagination. While the procedure itself was successful and the patient is recovering well, the presence of the ascaris came as a surprise to everyone involved. It serves as a stark reminder of the complexity of the human body and the need for vigilance during surgical procedures.

Conclusion

In conclusion, encountering an ascaris during a colonoscopy was an experience that I will certainly never forget. It underscores the unpredictable nature of medicine and the importance of staying alert, even in the most routine procedures. While such an event is rare, the experience serves as a valuable reminder for all medical professionals, ensuring that we maintain both our professional standards and our sense of humor in the face of the unexpected.

Keywords: intestinal parasites, colonoscopy, ERCP