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Ampullary Stone (EUS + ERCP)

A 27 y Old F, diagnosed as a case of severe cholecystitis (empyema), high grade fever recurent vomiting. Presented to the ER, admitted next day for cholecystectomy, which was not easy one due to severe inflammation and congestion. Three days post O.P. she became very well, pain free, till severe pain brought her again to the ER, INX: Normal LFT, Pancreatic amylase and lipase, WBC 13 × 10 (9), US was normal CBD, apart from small amount of fluid at the site of CCE bed. Drain output was 950 ml in the last 24 hr. MRCP: Normal CBD Caliber with very suspicious barely seen distal filling defect, and thats expected due to Normal CBD CALIBER (4.5 mm). EUS was done and the result seen below.