This 85 year old lady presented with obstructive jaundice secondary to a Klastkin tumor. These tumors represent some of our most time consuming cases. On contrast injection, a sharp cutoff was seen at the level of confluence (A: white arrow). We tried to negotiate it with a 0.035 inch guidewire but were unsuccessful. A thinner, 0.025 inch wore was able to cross it (B: white arrow). We then attempted to dilate the track with an 8.5 French dilatation catheter (C: white arrow). Despite significant twisting and turning on our part (some moves would make Christopher Walken proud), the catheter wouldn't go across. We opted for a thinner 7 French dilator which was successfully forced up to level of dilated intrahepatic ducts (D: white arrow). The plan was to dilate the track further using a 10 French TTS balloon (E: white arrow). This however couldn't pass fully beyond the upper end of the stricture and inflation caused to slip backwards repeatedly. Finally, with a thin track that just wouldn't allow anything fatter than 7 French and contrast ominously pooled in the upper system, we passed a 12 cm long plastic stent of 7 French diameter (F1:white arrows). The reward was a gush of our injected contrast (F2: white arrow).
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