Abstract:

A 66-year-old female patient, who was a farmer, went to the local county hospital on February 15, 2022 for treatment due to upper abdominal pain and nausea for 7 days. The abdominal CT examination showed dilatation of the common bile duct, intrahepatic bile duct stones in the left lobe of the liver and dilatation of the left lobe of the bile duct, and atrophy of the left lobe of the liver. She was transferred to the 924 Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army in the following day. The patient lived in the mountain area of Guilin, Guangxi and had history of drinking uncooked mountain spring water and ate raw Houttuynia cordata for a long time. There was positive tenderness but no rebound pain under the xiphoid process at admission examination. Laboratory test showed normality in routine blood test. Abdominal enhanced MRI examination showed that the left lobe of liver was atrophied, the intrahepatic bile duct in the left lobe of liver and common bile duct were significantly dilated, and granular or strip T2 low signal shadow was seen in the bile duct. After excluding the relevant surgical contraindications, endoscopic retrograde cholangiopancreatography was performed. During the operation, a viable Fasciola hepatica was removed with a basket, and the nasal bile duct was retained for drainage. The worm was transferred to the Department of Human Parasitology in Basic Medical College of Guilin Medical College and identified as Fasciola hepatica. After the operation, 0.6 g of albendazole and 0.6 g of praziquantel were given orally every 12 hours for 2 days. After two months of operation, the patient had no symtoms. CT examination showed atrophy of the left lobe of the liver and dilation of intrahepatic bile duct in the left lobe of the liver and common bile duct.

Key words: Fasciola hepatica, Endoscopic retrograde cholangiopancreatography