Abstract
Question: A 40-year-old woman was admitted to our clinic with a 1-month history of intermittent mild right upper quadrant pain and low-grade fever. No additional symptoms were reported. Patient history did not reveal any other significant past medical history and she was not taking any medication. Mild tenderness was observed on her right upper abdomen. Laboratory evaluations revealed eosinophilia (7%), and increased alkaline phosphatase (1012), gamma-glutamyl transferase (670), and direct bilirubin (3.3) levels. Other blood tests were normal. Abdominal ultrasonography revealed a motile, hyperechoic object in a mildly dilated common bile duct (Video A). Endoscopic retrograde cholangiopancreatography (ERCP) was performed and motile objects were drawn out from the bile duct (Video B). What is the diagnosis, what additional history would be helpful, and what treatment is necessary?
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