DISCUSSION
C. sinensis is most often reported in east Asian countries, including China, Korea, Japan and Vietnam, with approximately 35 million infected individuals[8]. Some studies have estimated that 12.49 million people have been infected with C. sinensis in China[9]. C. sinensis is mainly transmitted to humans from ingestion of freshwater fish[1]. However, our patient had no history of eating raw freshwater fish. Because of the nonspecific and atypical symptoms, C. sinensis infection has always been under-recognized, and often leads to clonorchiasis[10]. This patient had common bile duct stones with acute cholangitis and gallbladder stones with acute cholecystitis. Intraoperative exploration of the common bile duct revealed C. sinensis . It is not easy to diagnoseC. sinensis infection before surgery. The preoperative MRCP examination of this patient showed no dilation of the common bile duct. Lack of clarity in the lower common bile duct was unlike the dilation caused by conventional common bile duct stones[11]. Based on that, the possibility of bile duct parasites should be considered by radiologists and surgeons.
After surgery, the patient was treated with routine anti-infective agents and administered hepatoprotective and choleretic drugs, and praziquantel[12]. The T-tube did not drain theC. sinensis body, and deworming treatment was given. After treatment, liver function improved significantly. Coexisting gallbladder stones, common bile duct stones, and C. sinensis is relatively rare. Previous studies and case reports[5,9,11]suggest that C. sinensis might cause gallbladder stones by weakening the function of the gallbladder and causing the precipitation of bilirubinate, calcium carbonate crystals, and mucin on C. sinensis eggs. It is possible that the common bile duct stone and gall bladder stones in our patient were caused by the C .sinensis infection.