• A 66 yrs male was sent to us in favour of Endosonographic examination was considered to evaluate a suspicious filling defect in the lower CBD seen on other imaging studies with mildly abnormal LFT. Patient had pain in the right hypo quandrium and gall bladder also appeared distended without stone on other imaging studies. Patient had been having recurrent fever with chills for the last few months
  • EUS showed a massively dilated CBD 20 mm with a large 18 mm stone
  • Duodenoscopy revealed perivaterian diverticulum – selective cannulation of bileduct was achieved
  • Cholangiogram showed the same as EUS findings
  • Biliary sphincterotomy was performed followed by balloon sphincteroplasty
  • Stone extraction was carried out with balloon catheter

Take Home Message: Role of EUS sos ERCP cannot be over emphasized in this case. Any patient with recurrent cholangitis and unknown etiology can benefit with a very highly accurate diagnosis on EUS. As you have seen here that despite the large size of the stone 2.0 cms x 1,6 cms we did not require either mechanical lithotripsy or any other advanced techniques. This procedure was performed on an OPD basis and patient was sent home the same evening.

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1. EUS showed massively dilated CBD 20 mm with a large 18mm stone

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2.  Selective cannulation of bileduct

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3. Cholangiogram showed massively dilated CBD 20 mm with a large 18 mm stone

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4.  Biliary sphincterotomy was performed

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5. Biliary balloon sphincteroplasty performed

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6. Stone extraction was carried out with balloon catheter

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7. Stone was carried out with Dormia basket

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8. The large stone was removed approximately measuring 2cm

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