This lady had been having biliary type pain for the past two years. Her bilirubin levels were normal and alkaline phosphatase was mildly raised. The ultrasound suggested possibility of distal CBD sludge. The MRCP also suggested presence of sludge in the distal CBD (A: green arrow). There was an anomaly which appeared to be a stricture at the level of confluence. The radiologist reported that it was due to the hepatic artery crossing over the CBD (A red arrow). During ERCP, CBD access was very difficult and required an extensive papillotomy. The reason for posting the image (B) is because we encountered a problem faced by many when papillotomy is done. There was a fold of intestine above the ampulla (B: green arrows). This fold kept coming down with every peristaltic intestinal movement and kept touching the cutting wire (and hence getting cut in the process). The cholangiogram showed no negative shadows in the distal CBD (C1 & C2: green arrow). The anomaly seen in the upper CBD in the MRCP was not present in the cholangiogram (C1& C2: red arrow). A very extensive papillotomy was required. There was no sludge or stone in the CBD. A clean sweep with biliary balloon was done. A diagnosis of sphincter of Oddi dysfunction was made.
No comments:
Post a Comment