This 70 year old lady had a hilar cholangiocarcinoma. Going in, we were greeted by a cave of a diverticulum (A: blue arrows show the edges of the diverticulum and white arrow points to the duodenal fold with overlying papilla). Finding the papilla within the diverticulum and then cannulating (B: white arrow) it was extremely tricky and required a significant amount of wrist, elbow and torso movements. Contrast injection confirmed the tumor stricture at the area of confluence (C: white arrow. The red arrow points to the anomaly at the lower end of CBD, which was possibly due to the diverticulum). We passed a 10 French plastic stent of 12 cm length (D: white arrows. E: The ampulla "pulled" out of the diverticulum due to the lower end of stent resting on its edge).
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