Ms. Hoa had undergone gallbladder removal surgery for gallstones one year prior. Recently, she developed sudden, worsening abdominal pain that pain medication could not alleviate, prompting her visit to Tam Anh General Hospital, Ho Chi Minh City. Blood test results showed her eosinophil count (a type of white blood cell in the body's immune system) was 10 times higher than normal (typically below 5%).

Doctor Tran Thanh Binh, from the Center for Endoscopy and Endoscopic Gastrointestinal Surgery, stated that the patient exhibited mild jaundice, a sign of biliary parasitic infection. Ultrasound and CT scans revealed multiple common bile duct stones causing obstruction.

Ms. Hoa underwent endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and treatment. Contrast imaging showed a dilated common bile duct measuring 12 mm, with stones 10-12 mm in size at the distal end, and a deformed mid-biliary segment. After sphincterotomy and dilation, the medical team used a basket and balloon to remove one large stone and numerous fragments.

During the stone extraction, doctors also removed a liver fluke, approximately 12 mm long, from within the common bile duct. The bile duct was then flushed clean, and a follow-up check confirmed no remaining stones and good bile flow.

Doctor Binh (in a blue shirt) performs endoscopic retrograde cholangiopancreatography to remove stones and liver flukes. *Photo: Tam Anh General Hospital*

Following the intervention, Ms. Hoa's pain and fever subsided, she resumed normal eating, and was discharged one day later.

Liver flukes include small liver flukes and large liver flukes. Ms. Hoa was infected with large liver flukes, which are typically transmitted through the digestive tract when consuming raw aquatic vegetables or unboiled water. Upon entering the body, larvae hatch in the duodenum, penetrate the intestinal wall, and migrate to the liver and bile ducts to parasitize. Previously, this condition was quite common; however, it has become less frequent in recent years due to increased awareness of food safety and hygiene, according to Doctor Binh.

Symptoms of liver fluke infection are often vague and easily mistaken for common stomach or hepatobiliary conditions. Patients may experience dull pain in the right hypochondrium, bloating, loss of appetite, fatigue, and occasionally hives or a mild fever. Some cases are incidentally discovered during blood tests that reveal elevated eosinophil counts.

Doctor, First Degree Specialist Hoang Lac Long, from the Center for Endoscopy and Endoscopic Gastrointestinal Surgery, explained that when flukes migrate into the common bile duct, they can cause biliary obstruction, facilitating the formation of gallstones or exacerbating existing stone conditions. Individuals who have undergone gallbladder removal can still develop bile duct stones due to various factors, including altered bile composition, infection, or parasites.

To prevent liver flukes, everyone should "eat cooked food and drink boiled water," limit consumption of raw vegetables, avoid untreated water, and undergo deworming once every 6-12 months as advised by healthcare professionals. Should any unusual symptoms arise, patients should seek examination at a Hepatobiliary-Pancreatic specialty clinic for early diagnosis and treatment, thereby preventing dangerous complications.

Quyen Phan

*Patient's name has been changed