This lady was referred to us from another hospital. A T tube had been placed following cholecystectomy the post operative ultrasound and T tube cholangiogram suggested that there was a retained stone in the CBD. Contrast injection identified a negative shadow in the upper CBD (A: blue arrow. White arrow marks the T tube). We removed the T tube and performed a balloon sweep which resulted in not one but two stones (B1 & B2: white arrows. The second was a perfectly cut diamond!). An occlusion cholangiogram with contrast injection over a fully inflated balloon (C: white arrow) showed a clear CBD.
I am a gastroenterologist. This is a blog of the ERCPs and related endoscopic procedures carried out at my department. Dr Adnan Salim.
Wednesday, January 29, 2014
An extraordinarily large duodenal diverticulum
Tuesday, January 28, 2014
Tackling a large stone in an old lady
Friday, January 3, 2014
Gastric outlet obstruction secondary to duodenal ulcer induced stricture
This patient was a 65 year old lady who had developed duodenal luminal stenosis after healing of a large duodenal ulcer. On endoscopy, the duodenal lumen was reduced to a pinhole just beyond the bulb (A: white arrow). We were using an Olympus dual channel scope. We decided to use a straight ERCP cannula to try and go through the stricture (B) but even that couldn't go through. We were however able to get a guidewire across the stricture after engaging it with the cannula (C: white arrows). This was followed by dilatation of the strictured track with graduated dilatation catheters (D1, D2 & D3: white arrows). A stent assembly was then placed across the stricture (E: white arrows) and an uncovered self expanding metallic stent of 20mm diameter and 130mm length was deployed (F1 & F2: white arrows. Red arrows show the "waist" of the stent due to the strictured area. G1, G2 & G3: the stent going through expansion).
Thursday, January 2, 2014
Bile duct injury and calculi post cholecystectomy
Metastatic gallbladder cancer infiltrating into liver
This 85 year old gentleman had obstructive jaundice due to a locally infiltrative, metastatic gallbladder tumor. This case was difficult from the word go. We had to dilate the pharyngo-esophageal area with a 45 French dilator as the ERCP scope wouldn't go across. We saw extensive esophageal candidiasis. Maneuvering the scope across the pylorus was extremely difficult as well. However, once in, cannulation was achieved swiftly. Contrast injection showed a long stricture due to the tumor (A: white arrows). After placing a stent assembly across the strictured segment (B: white arrows), a self expanding metallic stent of 10mm diameter and 80mm length was deployed (C1 & C2: white arrows).
A very long biliary stricture secondary to cholangiocarcinoma
This 54 year old gentleman had obstructive jaundice due to a metastatic cholangiocarcinoma and was due to undergo placement of a self expanding metallic stent. Going in, we were welcomed by a worm at the junction of bulb and descending duodenum (A: white arrow). Contrast injection showed a sharp cutoff above the mid CBD (B: white arrow). The guidewire was placed across the strictured segment after some maneuvering and contrast injection showed the extent of the stricture (C: white arrows) and dilated intrahepatic ducts. The stent assembly was then positioned across the tumor area (D: white arrows). A 10 mm wide 10 cm long uncovered self expanding metallic stent was deployed (E: white arrows).
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...
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This patient was a 20 year old gentleman who had suffered blunt abdominal trauma during motorcycle accident. He developed a pancreatic absce...
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This 60 year old gentleman had earlier undergone ERCP and stenting for an anastomotic biliary leakage a few months earlier http://ercp365.bl...
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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...