Gastric outlet obstruction had resulted in this 70 year old gentleman due to his ampullary tumor infiltrating into his duodenum. He had earlier undergone stenting of the common bile duct for obstructive jaundice. First a plastic stent followed a few weeks later by a self expanding metallic stent. Unfortunately, only a couple of weeks later he developed symptoms of gastric outflow obstruction. The tumor had invaded the duodenal wall. On endoscopy, the previously placed metallic biliary stent was seen (A: red arrow) with the tumor tissue obstructing the duodenal lumen at the junction of bulb and descending duodenum (A: green arrow). It was decided to place a 22mm x 90mm self expanding metallic stent. The stent assembly was manoeuvred across the strictured area under flouroscopic guidance followed by contrast injection to confirm luminal patency beyond the strictured segment (B: red arrows). The stent was then deployed (C: green arrow. This is a classic picture of a patient with gastric outflow obstruction: a stent being placed on the right, stomach full of fluid due to obstruction on the left and the obstructed duodenal lumen in top middle). The stent was deployed successfully (D). The final image showing the fully deployed stent (E: green arrow) with the previously placed metallic (E: red arrow) and plastic (E: yellow arrow) biliary stents.
I am a gastroenterologist. This is a blog of the ERCPs and related endoscopic procedures carried out at my department. Dr Adnan Salim.
Subscribe to:
Post Comments (Atom)
Second (actually 3rd) ERCP for post transplant biliary leak
This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.bl...
-
This patient was a 20 year old gentleman who had suffered blunt abdominal trauma during motorcycle accident. He developed a pancreatic absce...
-
This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.bl...
-
This 40 year old lady had presented with a stricture of the CBD at the level of the cystic duct following a cholecystectomy. We had passed...
No comments:
Post a Comment