At that time we hadn't been able to access the CBD. Going in now, the swelling had greatly subsided and we were bale to identify the bile duct clearly (A: black arrow indicates the CBD and white arrow shows the wide open pancreatic duct ). The CBD was cannulated (B: black arrow) followed by contrast injection (C) which outlined a normal calibre CBD with no negative shadows. We decided to do a sphincterotomy (D: white arrow) and swept the CBD with biliary balloon (E: white arrow shows the balloon inflated in the CBD). As suspected, it was a clean sweep and no stones or sludge was extruded.
I am a gastroenterologist. This is a blog of the ERCPs and related endoscopic procedures carried out at my department. Dr Adnan Salim.
Saturday, March 29, 2014
Follow up CBD clearance after initial clearing of pancreatic duct
At that time we hadn't been able to access the CBD. Going in now, the swelling had greatly subsided and we were bale to identify the bile duct clearly (A: black arrow indicates the CBD and white arrow shows the wide open pancreatic duct ). The CBD was cannulated (B: black arrow) followed by contrast injection (C) which outlined a normal calibre CBD with no negative shadows. We decided to do a sphincterotomy (D: white arrow) and swept the CBD with biliary balloon (E: white arrow shows the balloon inflated in the CBD). As suspected, it was a clean sweep and no stones or sludge was extruded.
Thursday, March 13, 2014
Second follow up ERCP for post transplant anastomotic biliary stricture (CASE D)
Friday, March 7, 2014
Managing pancreatitis with a blocked pancreatic duct and ascites
Thursday, March 6, 2014
Uncommon biliary tree anatomy
This 54 year old lady had been referred for management of choledocholithiasis prior to undergoing a cholecystectomy. The ultrasound report suggested a single stone in the mid CBD. Initial contrast injection outlined the stone (A: white arrow). Things were about to get interesting, however as further contrast made the picture clearer. We could now see the stone (B: white arrow), the cystic duct (B: blue arrow) and what appeared to be a dividing line right in the middle of the CBD (B: red arrow). And even more contrast finally showed us what we were dealing with: double common bile duct with a common opening with the stone in the left stem (C: white arrow), right and left hepatic ducts draining separately into right and left bile ducts (C: yellow arrows), the cystic duct draining into the right bile duct (C: blue arrow). The arrowheads show black areas which are actually bile ducts viewed head on (C: red arrowhead shows the entrance of the cystic duct into the right bile duct). The stone was removed with an extraction balloon after sphincterotomy (D). The last diagram (E) shows the the modified classification of extrahepatic bile duct duplication as proposed by Choi et al.. Ours seems to be a Va type. The important thing here is the clear communication of this abnormal ductal anatomy to the surgeon who will be doing her cholecystectomy so as to prevent any inadvertent ductal injury and compromised drainage of any of the hepatic lobes.
Tuesday, March 4, 2014
Third follow-up ERCP for post transplant biliary stricture (CASE B)
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...