Obstructive jaundice often stems from gallstones or malignancies; however, clinicians must also consider parasitic infections in their differential. A timely hepatic fascioliasis diagnosis is crucial for patients presenting with atypical biliary symptoms. This case highlights a 40-year-old South Asian female who experienced a three-month history of right hypochondrial pain and nausea. Consequently, her laboratory results revealed cholestatic jaundice, prompting further investigation.

Case Presentation and Imaging

The patient presented with vague abdominal discomfort and poor appetite. Initial abdominal ultrasound showed gallbladder sludge and a dilated common bile duct (CBD). Notably, these findings are common in various hepatobiliary conditions. Therefore, clinicians proceeded with an endoscopic retrograde cholangiopancreatography (ERCP) to identify the specific cause of the obstruction.

The Impact of ERCP on Hepatic Fascioliasis Diagnosis

During the ERCP procedure, the medical team discovered live Fasciola hepatica worms within the biliary tree. This discovery facilitated a definitive hepatic fascioliasis diagnosis while simultaneously allowing for therapeutic intervention. The physician successfully extracted the parasites using balloon and basket catheters. This approach effectively relieved the biliary obstruction and addressed the patient's symptoms immediately.

Management and Patient Outcome

After the mechanical extraction of the worms, the patient received pharmacological treatment. Specifically, she was treated with albendazole to ensure the eradication of any remaining larvae. Her symptoms resolved completely within weeks. Furthermore, follow-up tests showed a total normalization of liver biochemistry. This outcome demonstrates that a combination of endoscopic intervention and anti-parasitic therapy ensures optimal recovery.

Clinical Pearls for Practice

Healthcare providers should maintain a high index of suspicion for fascioliasis in endemic regions. Although human infections are uncommon, they are increasingly reported. Early diagnosis prevents complications like secondary sclerosing cholangitis. Additionally, multidisciplinary coordination between radiologists, gastroenterologists, and infectious disease specialists is essential.

Frequently Asked Questions

How do humans contract Fasciola hepatica?

Humans generally contract the infection by ingesting metacercariae found on contaminated aquatic plants, such as watercress. Additionally, drinking contaminated water can also serve as a route of transmission.

What imaging findings suggest biliary fascioliasis?

Ultrasound or CT may show biliary dilatation and non-specific filling defects. However, ERCP or MRCP are more sensitive for identifying the characteristic leaf-shaped worms within the bile ducts.

Is albendazole the standard treatment for liver flukes?

Triclabendazole is the preferred drug of choice globally. Nevertheless, albendazole is frequently used as an alternative in various clinical settings, often resulting in successful resolution as seen in this case.

Disclaimer: This content is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here. Refer to the latest local and national guidelines for clinical practice.

References

Altaf A et al. The uninvited guest: live fasciola hepatica as a cause of obstructive jaundice-a case report. J Med Case Rep. 2026 Apr 25. doi: 10.1186/s13256-026-06013-y. PMID: 42032762.

Mumcu N, et al. Fasciola hepatica in the differential diagnosis of a patient with obstructive jaundice and eosinophilia. Infect Dis Clin Microbiol. 2022;4(4):289-92. doi: 10.36519/idcm.2022.130.

World Health Organization. Fascioliasis. Fact sheet. 2023.