Tumor of the pancreatic head causing an unusually long biliary stricture

A 55 year old patient with metastatic tumor of the head of pancreas. The ampulla seemed normal. Contrast injection outlined dilated intrahepatic bile ducts (A: white arrows) and a dilated upper CBD. The mid and lower CBD was strictured and narrow (A: green arrows). We did a small papillotomy to allow the stent assembly to pass with ease and deployed a self expanding metallic stent of 8mm diameter and 80mm length (B: white arrows. C: white arrows show the deployed stent and washout of contrast from the biliary tree) . The longer stent was required due to a longer stricture, unexpected in tumors of the head of pancreas where usually 6 cm long stents suffice.