Biliary fascioliasis - A rare differential diagnosis of biliary obstruction

Fascioliasis is a zoonotic disease caused by Fasciola hepatica or F. gigantica. There are two phases of Fasciola infection. In the acute phase, the patient has a wide spectrum of clinical manifestations while the later phase of infection is usually related to inflammatory changes in the bile duct and the mechanical effects of the worm, which can lead to biliary obstruction. The presence of Fasciola inside the biliary system has rarely been reported in the literature. In this report, we presented a case of bile duct obstruction in a 36-year-old male patient undergoing cholecystectomy for gallstones and with a history of worsening jaundice for one month. Extensive laboratory testing failed to clarify the cause of jaundice. Three living liver flukes were subsequently retrieved from the right hepatic duct and later confirmed as F. gigantica by morphology and internal transcribed spacer (ITS2) sequence analysis.