Live large flatworm in intestine

A 40-year male presented to the emergency department with the complaints of Fatigue that had progressively worsened over the period of 3 months. He had recently emigrated from Mexico, where he worked on a farm and eaten raw watercress. Clinical examination revels pallor of oral mucosa. Laboratory findings showed an increased in absolute Eosinophil count of 1400 cells per cubic millimeter (reference range 0-400). Ultrasonography of the abdomen reveled intrahepatic biliary ductal dilatation and magnetic resonance cholangiopancreatography revealed a hilar stricture. Endoscopic retrograde cholangiopancreatography was then performed and Large Flatworm were visualized emerging from major duodenal papilla.