A blocked stent within a blocked stent

This 78 year old gentleman had undergone ERCP for a Klastkin tumor three months ago. The procedure was unsuccessful and he was then referred for a PTBS (percutaneous transhepatic biliary stenting) following which a self expanding metallic stent was placed. Two months later, his stent was blocked and he underwent an ERCP in which a double pigtail 10 French diameter stent of 10 cm length was placed within the metallic stent (A: white arrows show the extent of the metallic stent and black arrows indicate the curved ends of the plastic stent within it ). This plastic stent lasted for over a month before being blocked (B: white arrow marks the blocked metal stent and blue arrows indicate the curled distal end of the plastic stent). The plastic stent was retrieved with a snare (C). Contrast injection outlined the intraheptic channels and the guidewire was advanced beyond the stent (D: white arrow shows the extent of the metallic PTBS stent and black arrow shows the guidewire beyond its upper end ). On retrieval, the sheath of the guidewire tip was broken and left inside (E: black arrow). The next image shows a more clear outlining of the left ductal system (F: white arrows). The metal stent and biliary tree was flushed with saline and an 11 cm straight plastic stent of 10 French diameter was placed (G: white arrows show the metal stent and black arrows show the new plastic stent protruding at both ends. H: the new plastic stent within the metal stent as seen in the duodenum).