ERCP胆道双支架双导丝插管

                               
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A 64 year old man presented with abdominal pain and initial investigations suggested a perforated appendix. However, laparoscopy showed a normal appendix and so an open operation was undertaken. A necrotic perforated gall bladder was found. A difficult open cholecystectomy was performed (cystic artery not identified, cystic duct clipped x2). Post operatively, large volumes of bile were drained from the sub hepatic drainage tube indicating a biliary leak. An ERCP was performed 4 days post operation.

Biliary cannulation proved difficult with the pancreatic duct inadvertently accessed multiple times with the guide wire. Biliary access was eventually secured using a double wire technique and double duct stenting performed.