A Young Man from Peru with Fever and Abdominal Pain

Diagnosis: Fascioliasis. Before the patient underwent cholecystectomy and endoscopic sphincterotomy, CT of the abdomen revealed calcifications within the gallbladder wall, multiple calcifications within a mildly enlarged common bile duct, and a large, irregular, crescent-shaped, calcified density in the proximal portion of the duodenum (figure 1). After the patient underwent cholecystectomy and endoscopic sphincterotomy, his symptoms resolved, and his liver enzyme levels returned to reference ranges. Histopathologic findings included acute and chronic cholecystitis with a focal granuloma that contained eosinophils and a calcified ovum of Fasciola species (figure 2). The worm that had exited the common bile duct was identified as Fasciola