This 54 year old gentleman had earlier undergone ERCP and stricture dilatation followed by plastic stent placement in December last year http://ercp365.blogspot.com/2013/12/post-liver-transplant-anastomotic.html. He had a 12 cm long 10 French plastic stent in situ. His bilirubin levels were rising and the ultrasound scan showed no pneumobilia. We found the stent to be blocked and removed it. A sweep of the bile duct with balloon extruded a large cast (A: white arrow). Following a clean sweep of the CBD (B), we placed a guidewire in the right anterior duct (C1 & C2: white arrow) and a second guidewire in one of the segment VIII ducts (C2: blue arrow). This was followed by TTS balloon dilatation with an 8mm diameter balloon of the segment VIII duct (D: white arrows) and of the site of anastomosis of anterior and segment VIII ducts with the main bile duct (E: white arrows). We then passed two plastic stents, both of 10 French diameter. The shorter, 12 cm stent was placed in the right anterior duct (F: black arrows). The longer, 15 cm stent was placed in the one of the segment VIII branches (F: white arrows).
