A 50 year old lady had developed obstructive jaundice over the past few months and had been admitted with recent onset of fever. She was found to have a mass lesion near the area of confluence. She had no co-morbids. On ERCP, our guidewire couldn't initially go beyond the proximal CHD. The cholangiogram showed the CBD and CHD, along with the sharp cutoff at the proximal CHD (A: white arrow). The cystic duct was also outlined (A: green arrow). The guidewire was finally placed across the strictured part after a few attempts and contrast injection outlined the full biliary tree. The right and left ductal systems were dilated and a stricture was seen just below the confluence (B: white arrow. This would seem to be a Bismuth Type I lesion). After dilatation with a 9 French graduated dilator, we passed a 12 cm long plastic stent of 10 French diameter to drain the biliary system. She will continue to recieve antibiotics and will be placed in our weekly multidisciplinary meeting for review and eventual surgery.
