A 69 year old lady presented with abdominal pain, jaundice and vomiting. Initial investigations: Bilirubin 120 umol/L, Alk Phosp 810, ALT 120. The ultrasound scan was reported as showing a dilated (16mm) CBD. The patient was thought to have cholangitis and was referred for ERCP. This procedure turned up two unexpected, rare, surprises.
Firstly there was a double major papilla, a supposedly very rare congenital anomaly where the CBD and duct of Wirsung remain as independent ducts and open into the duodenum separately. Apparently only a handful of documented cases have been described in the literature. In one report the double papilla was seen in only 3 cases out of 1600 patients undergoing ERCP (0.18%). Despite the rarity, this was the second case that I saw within a space of a few days!
The second unexpected surprise came after achieving a cholangiogram which revealed a biliary stricture with a choledochogastric fistula. See video for ERCP… |
骶骨阴道固定术 _ 穹窿脱垂 - 膀胱膨出
进行增强型手术 - 腹腔镜胆囊切除术用例
肋下切口疝，Metin Ertem MD.FACS
胆囊积脓_腹腔镜胆囊切除术治疗困难胆囊
发表于 2017-5-4 21:40:59
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