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case_images: The diagnosis and migration of Clonorchis sinensis under direct endoscopic observation. (A) The conventional procedure of common bile duct intubation and nipple incision. (B) The anterior portion of C. sinensis is clearly visible as it emerges from the Vater's ampulla. Black arrow pointed to the oral sucker, white arrow denoted the abdominal sucker. (C,D) The anterior and most of the body of C. sinensis have already entered the duodenal lumen, black arrow indicates the uterus of C. sinensis. (E) The worm had completely entered the duodenal cavity. (F) Cholangiography revealed the presence of a common bile duct stone shadow.
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case_images: During the procedure, following routine duodenal papilla intubation and sphincterotomy (Figure 1A), an unexpected discovery was made: worms emerging from the ampulla of Vater (Figure 1B). The body exhibits a flat form, devoid of spiny epidermis, and the diameter of the oral sucker surpasses that of the ventral sucker (Figure 1C). Upon the worm's emergence, the intricate branching of the ovaries became distinctly visible, as shown in Figure 1D. Ultimately, the worm fully navigated into the intestinal cavity (Figure 1E). Cholangiography analysis revealed a void in filling at the terminus of the common bile duct, indicative of a stone shadow (Figure 1F).
case_images: Multiple repeated fecal examinations finally identified the presence of C. sinensis eggs.
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case_images: Based on meticulous morphological assessment of the parasite's body and repeated fecal egg examinations (Figure 2), a diagnosis of C. sinensis infection was confirmed.
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case_images: Morphological characterization of Echinostoma worms and their Eggs. (A) Gastro-duodenoscopic visualization of worms adhered to intestinal mucosa. (B) Microscopic examination of worm morphology in vitro. (C) Egg morphology obtained from worms.
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case_images: fig3
case_images: During a gastroduodenoscopy procedure, a significant finding emerged: multiple motile trematodes were observed adhering to the duodenal wall (Figure 3A). A detailed examination under a stereomicroscope revealed an opaque worm body, accompanied by prominently visible oral and abdominal suckers (Figure 3B). Then eggs were obtained from the adult worms, their morphological characteristics mirrored those of Echinostoma (Figure 3C).
case_images: Image of nucleic acid gel after gene amplification by PCR. (A) Amplification results of ITS sequences of two E. hortense worms. (B) Amplification results of 18S and COX-1 sequences of two E. hortense worms.
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case_images: TTT CCT CCG CT-3', and the reverse primer sequence was 5' -GTA GGT GAA CCT GCG GAA GGA TCA TT-3'. The gel image distinctly reveals a clear band at 1200 bp, corroborating the expected size of the target gene (Figure 4A). Then this target band was excised, purified, and subsequently sequenced. TCG CTG CTA, and COX-1 reverse primer: CCT CCA CCA ACC TAA CCT. 18S forward primer: 5'-CTG GTT GAT CCT GCC AGT AGT C-3', 18S reverse primer: 5'-ACG ACT TTT ACT TCC TCT AAA T-3'. The PCR product of 18S was sequenced, and the results showed that the product had two peaks, proving that the product is non-specific. The COX-1 sequences were successfully amplified (Figure 4B), and homology analysis unveiled a perfect match of 100% with the COX-1 gene of Echinostoma hortense, conclusively diagnosing the patient's condition.