This patient was an obese 35 year old lady with systemic hypertension and heart disease. She had been referred from another facility for ERCP and removal of CBD stones prior to undergoing a cholecystectomy. The case turned out to be a tough one. We were able to cannulate the pancreatic duct and went for a transpancreatic papillotomy. CBD cannulation followed. Surprisingly, there weren't any stones inside (A: green arrow & B) neither did the ampulla look like a stone had passed through it.
The CBD showed a short stricture in its terminal part. We passed a plastic stent (C: green arrow)and admitted her for overnight monitoring as she had gotten quite restless (the procedure wasn't being done under propofol sedation) and her blood pressures had shot up. The patient was underwent an abdominal x ray which was normal. A CT scan however showed free air in the retroperitoneal space (D: red arrows). She was afebrile and bowel movements were normal. It was decided to manage her conservatively. She was improving 96 hours later.
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