ERCP ; End view EGD scope for altered anatomy approach to bile duct. скачать в хорошем качестве

ERCP ; End view EGD scope for altered anatomy approach to bile duct.

An elder male with long history of open cholecystectomy, over 30+ years ago, presented with liver abscess segment 4 size about 5-6cm but CT exmination also report of distal CBD stone size 7mm with aerobilia. ERCP first performed by using standard side view scope but found an jejunostomy anastomosis just behind pylorus in duodenal bulb with failure to access of which jejunostomy limb leading to bile duct. End view EGD scope with silicone cap attached was used for safe and easier approach to bile duct, which surprisingly found an efferrent stroma of jejunosotmy limb was at left side anastomosis. Fluoroscopic guidance to approach to choledochojejunal anastomosis with widely patent opening of bile duct at anastomosis site without any stone seen from occluded cholangiogram was observed, no CBD stone for removal.