A few weeks ago, one of our minimally invasive surgeons referred a patient from Shunde to me. The patient was admitted for recurrent biliary obstruction combined with cholangitis, and I performed an ERCP examination on the patient and found that the primary disease was hepatoportal cholangiocarcinoma, so I performed an elective resection of hepatoportal cholangiocarcinoma after a period of yellowing with internal stent drainage. During the surgery, when I opened the dilated bile duct above the malignant obstruction site, the light yellow bile flowed out with a clatter, and I noticed that there seemed to be some long black stripes floating out with it, so I used a syringe to aspirate part of the patient’s bile and put it in the basin. This is actually a hepatic schistosome, the scientific name of the testicular worm, as a biliary surgeon, this worm is often encountered in surgery. So, where did this worm come from? Why does it settle in the patient’s bile duct? What is the relationship with the patient’s disease? Let me tell you about it. History: Clonorchis sinensis, referred to as liver fluke, is parasitic in human bile ducts inside and outside the liver and in the gallbladder. Later, in 1975, archaeologists found more liver eggs in the liver of a male corpse excavated from the Han tomb in Jiangling, Hubei. This suggests that the disease has a long history in China, and that the history of the southerners being afflicted by this worm can be traced back at least 2000 years. The Pearl River Delta is a high prevalence area for this disease, and a survey in 2012 found that the proportion of liver fluke infections in the Wuyi area of Jiangmen could be as high as 10%. Life history Let’s briefly review the life history of liver fluke! The adult liver fluke parasites in the human liver and bile ducts, sucking the mucous membrane of the bile ducts and producing a large number of eggs, which enter the digestive tract with the bile and are discharged in the feces, and after the feces contaminates the water, the eggs enter the water, and their first “landlord” is a freshwater snail. At this time, the snail “small house” is not enough to live, so the larvae move again, they choose the second “landlord” is a freshwater fish and freshwater shrimp such as crustaceans, the larvae will invade the muscle tissue of the fish and shrimp, and develop into cysts. They live in a small vesicle in the muscle of the fish and shrimp to do “sorghum dream”, their biggest “dream” is that one day they will be eaten by gluttonous people, and then moved to an elegant environment, a lot of food “villa “inside to live. Fish and shrimp containing cystic larvae are swallowed by life, stimulated by digestive juices, and break out of the duodenum. They follow the bile in groups against the flow, or through the intestinal wall via blood transport to the intrahepatic bile duct, where they end up, the dream “villa”: the human bile duct. Here they mature sexually and, because they are hermaphroditic, have an incredibly well-developed male and female reproductive system. During the 20-30 years of adult life, they lay numerous fertilized eggs, which are expelled from the body and eventually form a wonderful and less glamorous life cycle. The adult liver fluke parasitizes in the hepatobiliary ducts, relying on oral and ventral suction cups fixed on the mucosa of the bile ducts, and without natural enemies, they live an incomparably nourishing life. They feed on the mucosal tissues of the bile ducts, tissue fluids and blood by means of powerful, constantly moving suction cups, which are rich in nutrients, while egg laying is their only task. Such gluttonous behavior can lead to the destruction of the epithelial mucosa and vascular connective tissues of the bile ducts, and when many worms gather, the bile ducts can become almost “perforated”. The secretions, metabolites and mechanical stimulation of the worms can cause repeated allergic and inflammatory reactions in the lining of the bile duct and around the bile duct, resulting in bile duct dilatation and epithelial hyperplasia. Bilirubin calcium, worm fragments, eggs and necrotic tissues in the bile can form secondary disasters such as bile duct stones and gallbladder stones. IV. How to detect the disease? The good news is that it is not difficult to diagnose the disease, and people who have eaten freshwater fish and are suspected of having the disease can be diagnosed by sending their stool to the hospital for testing and finding the eggs of liver fluke, which costs only about ten dollars. The subhepatic peritoneal cystic dilatation of small bile ducts, mainly in the perihepatic distribution, with similar diameter, etc. V. How to prevent? Almost everyone is not immune to liver fluke, but people should be “immune” enough to the delicious but dangerous temptation of raw freshwater fish. Schistosoma haematobium infection is a completely “oral” disease, mainly caused by eating raw freshwater fish and shrimp infected with liver fluke larvae. It has been experimentally confirmed that soy sauce, salt and other condiments cannot kill the larvae in raw fish within a few hours, and stomach acid and duodenal fluid cannot kill the larvae but activate them. Only a certain amount of time of heating can kill the larvae. There is also a risk of infection by using knives and cutting boards that have been used to cut raw fish, and by using utensils that have been used to serve raw fish. Therefore, it is important to avoid eating raw or semi-raw freshwater fish, freshwater and semi-saltwater marine fish, etc. to prevent the disease. The raw salmon sold in regular stores in the market is generally Norwegian artificially raised and frozen for a certain period of time, can be safely consumed. There are special drugs for this disease, namely praziquantel and albendazole (intestinal worms). General health stations, infectious disease hospitals, pharmacies are often stocked with these drugs, patients infected with liver fluke to respect the doctor’s advice to take can be cured of the disease.