IL4 and cholangitis: Ascariasis involves dual pathogenic mechanisms of immunopathology and mechanical injury: Larval migration triggers hepatic and pulmonary inflammation primarily through Th2-mediated pathways dominated by IL-4/IL-5/IL-13, while adult worms cause mechanical complications including intestinal obstruction (incidence: 3%–10%) and biliary ascariasis-induced cholangitis (0.5%–2%) (9, 10).