A 75 yrs female patient was referred to evaluate a suspicious filling defect in the lower CBD seen on USG scan with abnormal LFT. Patient has undergone cholecystectomy elsewhere many years ago. In view of these findings EUS and ERC was considered. EUS revealed normal CBD and gall bladder.

  • EUS revealed dilated CBD 11 mm with an 8 mm stone impacted just above the ampulla of vater in the lower CBD
  • One large 2.0 cms x 1.2 cms stone impacted in the cystic duct / CBD junction leading to a sort of Mirrizzi’s syndrome
  • Large cystic duct stump was seen with few small concrements along with a large cystic duct stone. Pancreas and MPD appeared normal
  • ERC was considered – Duodenoscopy revealed intra diverticular ampulla. Selective cannulation of bileduct was achieved
  • Cholangiogram showed large 2.0 cms x 1.2 cms stone impacted in the cystic duct
  • Biliary sphincterotomy was performed followed by small stone extraction. Balloon dilatation of the cystic duct /CBD junction was done over a guide wire
  • Post dilatation the large 2.0 cms stone was then gently extracted with a stone extraction balloon catheter
  • Occlusion cholangiogram confirmed complete ductal clearance
  • A 7 fr double pigtail stent was placed to ensure free flow of bile

EUS revealed large 2.0 cms x 1.2 cms stone impacted in the cystic duct

Selective cannulation of bile duct

 

 

 

 

 

 

 

 

Cholangiogram showed large 2.0 cms x 1.2 cms stone impacted in the cystic duct

Biliary sphincterotomy was performed

Biliary sphincterotomy was performed

 

 

 

 

 

 

 

 

Balloon dilatation performed of the cystic duct /CBD junction

Large 2.0 cms stone was then gently extracted with a stone extraction balloon catheter

 

 

 

 

 

 

 

 

Occlusion cholangiogram confirmed complete ductal clearance

A 7 fr double pigtail stent was placed to ensure free flow of bile

 

 

 

 

 

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