Cannulation of the Common Bile Duct Revealing Numerous Leaf-shaped Worms

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results of liver-function tests were abnormal, showing elevated levels of aspartate aminotransferase (350 IU per liter), alanine aminotransferase (352 IU per liter), alkaline phosphatase (204 IU per liter), {gamma}-glutamyltransferase (434 IU per liter), total bilirubin (6.4 mg per deciliter [109 µmol per liter]), and conjugated bili