Single-operator cholangioscopy unveiling a pinehole post-cholecystectomy biliary strictures.
Luís Português de Oncologia GomesMarta MoreiraIsabel TarrioAlda João AndradeTarcísio AraújoJorge CanenaLuís LopesPublished in: Revista espanola de enfermedades digestivas (2024)
77-year-old female with history of cholecystectomy was admitted at emergency department with fever and myalgia, without other complaints. Physical examination revealed fever, and laboratory tests indicated cholestasis (total bilirubin: 1.5xULN, glutamyltransferase: 20xULN, alkaline phosphatase: 5xULN). Computed Tomography revealed common bile duct (CBD) dilation (9mm), with suspected choledocholithiasis. Given the diagnosis of acute cholangitis, antibiotics were started and ERCP was performed. ERCP revealed a short CBD stenosis (< 2mm length), close to surgical clip, with upstream dilation of the CBD; an 8mm stone in the distal CBD was observed and successfully removed. As guidewire advancement failed after multiple attempts, a SpyGlass DS cholangioscopy was performed showing a fibrotic pinehole stenosis. Guidewire was passed through the stenosis under direct visualization, and an 80-mmx10mm fully covered metal stent deployed.
Keyphrases
- emergency department
- computed tomography
- single cell
- drug induced
- liver failure
- physical activity
- positron emission tomography
- magnetic resonance imaging
- minimally invasive
- idiopathic pulmonary fibrosis
- magnetic resonance
- intensive care unit
- extracorporeal membrane oxygenation
- adverse drug
- pet ct
- endoscopic submucosal dissection