A 38 year old lady with an ampullary tumor which had metastasized to the liver and duodenum (A: green arrows). On endoscopy, the ampulla was heavily infiltrated (B: green arrow). Cannulation was unexpectedly swift. Dye injection showed a grossly dilated CBD with a distal stricture (C: green arrows showing dilated CBD with red arrow showing the strictured segment). The guidewire was placed across the stricture (D: green arrows) and a self expanding metallic stent of 10mm diameter and 60cm length was placed (E: green arrows showing the stent and red arrow showing constricted part of the stent in the area of the malignant stricture). A gush of pus and bile was seen (F: green arrow) after stent deployment. The patient had developed cholangitis prior to the procedure. Hopefully this stent will help in resolution of the acute condition.
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