Metastatic gallbladder cancer infiltrating into liver

This 85 year old gentleman had obstructive jaundice due to a locally infiltrative, metastatic gallbladder tumor. This case was difficult from the word go. We had to dilate the pharyngo-esophageal area with a 45 French dilator as the ERCP scope wouldn't go across. We saw extensive esophageal candidiasis. Maneuvering the scope across the pylorus was extremely difficult as well. However, once in, cannulation was achieved swiftly. Contrast injection showed a long stricture due to the tumor (A: white arrows). After placing a stent assembly across the strictured segment (B: white arrows), a self expanding metallic stent of 10mm diameter and 80mm length was deployed (C1 & C2: white arrows).

Gall bladder malignancy

This 70 year old gentleman had a gall bladder mass with involvement of the porta hepatis and duodenum. The ampulla was fairly normal looking when we went in (A:green arrow), though maneuvering into the descending duodenum was a bit tricky. Contrast injection outlined a stricture in the proximal bile duct (B: green arrow) with pre-stenotic dilatation of intrahepatic channels. A self expanding metallic stent assembly was placed across the stricture (C: green arrow) and a 10 cm long stent of 10mm diameter was deployed (D: green arrows and E: green arrow).

Obstructive jaundice secondary to gallbladder tumor invading the common hepatic duct

This 80 year old gentleman had a CBD stricture secondary to a gallbladder tumor which was involving the distal common hepatic duct. His ampulla had classic openings of the bile duct (A:green arrow) and pancreatic duct (A: red arrow) so I decided to include its photo. These openings aren't always that clearly defined. There was also a small diverticulum supwrior to the ampulla (B: green arrow). Contrast injection outlined a stricture of the common hepatic duct (C: green arrow). The stricture was dilated with a 9 French dilator (D: green arrow) followed by placement of a self expanding metallic stent of 10mm diameter and 100mm length (E: green arrow & F: green arrow).

Note: You can have a detailed 3D view of the gallbladder and associated structure anatomy by clicking on this link http://www.healthline.com/human-body-maps/gallbladder

Gall bladder mass causing obstructive jaundice with possible fistulous tract

A locally infiltrating gall bladder mass had caused obstructive jaundice in this 50 year old lady. Contrast injection outlined a stricture at the level of the cystic duct (A: green arrow) and dilated intrahepatic ducts. Further contrast injection also outlined what appeared to be a fistulous tract adjacent to the CBD (B: green arrow). A 10F x 12 cm plastic stent was placed.

Biliary stricture secondary to infiltration by gallbladder tumor

Late stage gallbladder tumor (Stage III). A sharp cutoff of contrast seen (A). Guidewire was maneuvered across the strictured area followed by contrast injection which outlined dilated intrahepatic biliary channels (B: red arrow shows the stricture). A 10F x 10cm plastic stent was placed (C) after dilatation of stricture with graduated dilatation catheters.

Malignant biliary stricture secondary to infiltration by gallbladder tumor

This was a locally infiltrating gallbladder tumor. The images show the structured segment with sharp cutoff of contrast (A: Green arrow).  Dye injection after crossing the strictured segment showed dilated intrahepatic biliary channels (B). A 10F x 12cm plastic stent was passed.