Abstract
A 68-year-old man with situs inversus was admitted to our hospital with obstructive jaundice. An MRCP revealed intrahepatic biliary dilation with a long segment stricture of the common hepatic duct and abnormal signal within the hepatic parenchyma near the hilum (Fig. 1) . The patient underwent ERCP in the supine position (Video 1, available online at www.giejournal.org). Repeated attempts to cannulate the bile duct were unsuccessful. Initial engagement was possible, but the guidewire could could only be advanced into the pancreatic duct. A pancreatic precut sphincterotomy was performed in the opposite orientation at the 1 o’clock position in an attempt to expose the bile duct. Cannulation of the bile duct was still unsuccessful, so a needle-knife precut was performed in a 1 to 2 o’clock orientation. Cannulation of the bile duct was then achieved, and a biliary sphincterotomy was performed. Cholangiogram confirmed a common hepatic duct stricture with proximal upstream dilation. Brushings of the biliary stricture were performed over a guidewire. A 5F × 15 cm single pigtail plastic stent was deployed over a guidewire into the pancreatic duct. A 10 × 60 mm fully covered, self-expanding metal stent was deployed across the biliary stricture with successful biliary drainage post-deployment. Pathology from the biliary brushings revealed cholangiocarcinoma. Magnetic resonance angiography showed no vessel involvement and no distant metastases. The patient is currently awaiting surgical resection by the liver transplant surgical team.
Published Version
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