Ezzat et al. Journal of Medical Case Reports 2010, 4:83 http://www.jmedicalcasereports.com/content/4/1/83 169000/cmm; erythrocyte sedimentation rate (ESR), 45 mm/1st hour; alanine aminotransferase, 74 IU/L; aspartate aminotransferase 93 IU/L; gamma glutamyl transferase, 319 IU/L; alkaline phosphatase, 266 IU/L; and total serum bilirubin, 2.2 mg/dl. Results of her ultra- sonography revealed normal liver parenchyma, removed gall bladder, normal intrahepatic bile ducts and dilated common bile duct (12 mm). Her stool examination tested negative for ova. Endoscopic retrograde cholangiopancreatography (ERCP) was done to test for extrahepatic cholestasis. This revealed dilated common bile duct (with a diameter of 11 mm) and a filling defect in her common bile duct (Figure 1). During balloon extraction after her endoscopic sphincterotomy, one live FH was forced through her choledocus (Figure 2) and into the lumen of her duodenum (Figures 3 and 4) and then physically removed by biopsy forceps (Figure 5). We prescribed our patient with a single morning dose of 10 mg/kg of Tricalbendazole [3]. On her follow-up examination, after four weeks, her liver enzymes had returned to normal. Another ultrasonography revealed that the size of her bile duct was normal. Discussion A variety of liver flukes, including Fasciola hepatica, may colonize the biliary tree of humans where they lay their eggs. These eggs can give rise to the formation of gallstones by serving as nidus for them. Living or dead worms may occlude the bile ducts, thus causing obstruction and sometimes cholangitis. Fascioliasis is primarily a common disease of livestock animals such as cattle and sheep, with humans serving occasionally as accidental hosts. Two stages have been described in human fascioliasis: an acute phase, which coincides with hepatic invasion, Figure 1 Cholangiogram revealing a dilated common bile duct. Page 2 of 4 Figure 2 Fasciola coming out from the choledocus. Figure 3 Fasciola in the duodenum. and a chronic phase, which develops due to the pre- sence of flukes in the bile ducts [4]. The metacercariae for these parasites encyst on freshwater plants, such as wild watercress. Human consumption of aquatic plants harvested from contaminated areas can lead to infection. Subsequently, the developing larvae penetrate the gut wall and enter the peritoneal cavity. After a period of migration for six to nine weeks, the flukes penetrate the