This 84 year old lady had been admitted with cholangitis. Her ultrasound scan indicated a dilated CBD with a distal stricture. Her CA 19-9 level was also normal. The MRCP film confirmed the ultrasound findings of a dilated CBD with a distal narrowing (A: white arrow). Starting our ERCP, we were greeted with a duodenum full of diverticulae. Fortunately, the papilla was not at the bottom of one of these (B: white arrows indicating two adjacent diverticulae, with food residue in the left one. Blue arrow indicating the papilla. Black arrow indicating the duodenal lumen). Thankfully it didn't take too long to cannulate the papilla (C). Contrast injection showed the same findings as the MRCP (D) and we suspect that the lower narrowing in the CBD could be attributed to the diverticulae. We passed a 10 French 7cm long plastic stent (E1 & E2: white arrows).
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