A very large intrahepatic cholangiocarcinoma

This was a 30 year old gentleman who had presented with obstructive jaundice. His CT scan showed a very large mass of approximately 12x11cm occupying most of the left one (A: white arrows) with involvement of the porta hepatis and extensive intra-abdominal lymphadenopathy. On ERCP, contrast injection following placement of guidewire outlined a long stricture involving the region of ductal confluence (B: white arrows) with dilated  left sided ducts proximal to stricture (B: red arrows). Since the right system was not outlined, we left our first guidewire in the left system (C: white arrows) and attempted to pass a second guidewire in the right system (C: black arrows). This was unsuccessful. Luckily, no contrast had gone into the right system. We dilated the structured segment using a graduated 9 French dilatation catheter (D1 & D2: white arrows). A 12 cm long plastic stent of 10 French diameter was then deployed (E1 & E2: black arrows )