ERCP-胆囊切除术后胆漏

                               
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A frail 77 year old man with a previous right hemicolectomy (many years ago) was admitted under the surgeons with an acute abdomen. At laparotomy, there was a gangrenous perforated gall bladder containing a single large stone. A difficult cholecystectomy was performed and two Robinsons sub-hepatic drains were inserted (one later removed). He had a stormy post operative course with sepsis and required inotropic support on ITU. He developed an abdominal collection and required a CT guided pigtail drain.

Despite this, he remained unwell with sepsis and bile was draining from the sub hepatic drain. He was referred for urgent ERCP, 19 days following the original operation...