A 44-year-old woman presents with icterus, abdominal pain, nausea, and fever. On examination, the vital signs were normal. The abdomen was soft, with moderate tenderness in the right upper quadrant. Blood tests showed a normal white cell count (6,290 per mm 3 ) with eosinophilia (22%) and increased levels of total bilirubin (4.8 mg/dL), alkaline phosphatase (132 U/L), and alanine aminotransferase (101 U/L). The magnetic resonance cholangiopancreatography showed an enlarged common bile duct (1.1 cm), containing hypointense and heterogeneous material, suggestive of choledocholithiasis (Figure 1). The patient underwent an endoscopic retrograde cholangiopancreatography, which demonstrated radiolucent filling defects into the common bile duct (Figure 1). After sphincterotomy, the endoscopist observed the drainage of several live larvae from the biliary duct, similar to slugs (Figure 2). Fecal analysis confirmed the presence of eggs of Fasciola sp. On further history, the patient was discovered to be a nutritionist, reporting regular consumption of watercress, the likely source of fascioliasis. She was treated with triclabendazole for 2 days with prompt recovery. Figure 1. (A) Magnetic resonance cholangiopancreatography showing a hypointense filling defect (white arrow) into the distal part of the common bile duct, mimicking a gallstone. (B) Endoscopic retrograde cholangiopancreatography showing dilatation of the common bile duct, with radiolucent filling defects.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.