Long CBD stricture secondary to extrinsic compression

This 54 year old lady had a dilated gallbladder compressing the mid CBD upto the confluence (A: MRCP & B: CT scan ; Red arrows showing the dilated gallbladder. Blue arrows show the compression at the confluence and green arrows show dilated intrahepatic channels. C: CT scan; Red arrows marking the gallbladder). Contrast injection on ERCP outlined the narrowing in the CBD (D: black arrows) and dilated intrahepatic ducts. A stent assembly was placed across the affected segment (D). We passed a 15 cm plastic stent of 10 French diameter (E: white arrows show the stent loaded on its assembly. F: Black arrows show the stent passed across the structured segment and into the dilated intrahepatic channels)

Stenting a metastatic ampullary tumor

A 52 year old gentleman with metastatic ampullary tumor. His CT scan showed a grossly dilated CBD (A: white arrow). Ampullary infiltration was evident on ERCP (B: white arrow). Contrast injection outlined a markedly dilated CBD (C: white arrow). A 10cm long plastic stent of 10 French diameter was deployed (D1, D2 & D3: white arrows).

Tumor of the pancreatic head causing obstructive jaundice

A mass of approximately 21cm size in the region of pancreatic head was cashing obstructive symptoms in this 78 year old gentleman. He had also developed fever. His CT scan showed a dilated pancreatic duct (A1: green arrow)  with abrupt obliteration of its lumen (A2: green arrow) with an adjacent mass in the pancreatic head (A2: red arrow). On ERCP, his cholangiogram showed significant intrahepatic biliary dilatation (B: white arrows) with a stricture involving the distal CHD and proximal CBD (B: green arrows). He was in good physical shape and the remaining CT films didn't show any contraindications to resection. We placed a 10cm long plastic stent of 10 French diameter to drain the biliary system and resolve the infection (C: white arrows). He is due to undergo surgery soon after.