This 30 year old gentleman had developed biliary pancreatitis. He was treated at another facility a month ago where a papillotomy was done and his CBD was cleared of stones/sludge. A straight 10 French stent of 5 cm length was passed. The pancreatic duct could not be cleared at that time as duct access was unsuccessful. The patient was then referred to us. We were greeted with a post-papillotomy papillary with sign of the previous stent-it must have slipped keeping in mind the papillotomy (perhaps a pigtail stent shoulder been used). We were lucky in gaining rapid pancreatic duct access and congrats injection clearly showed two negative shadows (A: white arrows). The guidewire was then advanced further (B: red arrow) and a balloon assembly was then pushed over it (B: white arrow). The pancreatic duct was the swept with the balloon (C: white arrow shows the inflated balloon in the middle of the pancreatic duct). A lot of small white stones and sludge was removed by multiple balloon sweeps (D1 & D2: red arrows). An occlusion pancreaticogram with the balloon inflated at the distal end of the pancreatic duct (E: white arrow) showed a clear duct with no stones.
We then accessed the CBD (F: blue arrow shows the papillotome in the CBD. White arrow marks the opening of the pancreatic duct in the papilla). Contrast injection outlined a clear bile duct (G: red arrows show the bile duct. White arrows show the contrast in the pancreatic duct). The CBD was swept with balloon.
