This 25 year old gentleman had undergone a living donor liver transplant at out centre in July 2014 for Budd Chiari syndrome. He presented with jaundice and pruritus six months later in January this year. His MRCP films showed the level of stricture at the anastomotic site (A: red arrow). An attempt at ERCP a month ago was unsuccessful. However as our guidewire went multiple times into the pancreatic duct we placed a plastic stent in the pancreatic duct. A repeat attempt was now made (B: black arrow marks the papillotome and white arrow indicates the previously placed pancreatic stent). Initially we kept going into the pancreatic duct again (C: White arrows mark the guidewire and black arrow shows the stent in the pancreatic duct). We did a papillotomy to get more manoeuvring space for engaging the CBD (D: black arrow) and were rewarded with successful cannulation (E: White arrow shows our wire in the CBD). Contrast injection confirmed the MRCP findings with dilated intrahepatic ducts (F: black arrows) and a tight anastomotic stricture (F: white arrow). A 7 French plastic stent of 15 cm length was placed (G: black arrows).
