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A 64 year"s old patient presented at SQUARE HOSPITAL LTD Dhaka Bangladesh with H/O Acute calculus cholecystitis with obstructive jaundice. C/C: Upper abdominal pain for 10 days. Abdominal discomfort for 10 days. Pain aggravates after taking meal Vomiting for 3 days, 2 days back Constipation for 7 days. Yellowish discoloration of skin, sdera & urine for 10 days Generalized itching for 10 days. S/P PCI 2016. H/O IHD, DM, HTN MRCP WITHOUT CONTRAST REPORT WAS Technique: The patient was studied in 3T MRI system 2D breath hold MR hydrography was done to realize MRCP without contrast Axial, coronal, oblique sagittal 12. Axial T1 3D T2 space Findings: CBD is dilated and mildly tortuous. A intraluminal signal void structure (8mm) is seen in distal CBD.Length 70mm, diameter- 16mm. CHD is dilated. No intraluminal filing defect. Length- 33mm, diameter- 13mm. Cystic duct is inserted laterally Right and left hepatic ducts are mildly dilated. No intraluminal filing defect. Normal wall thickness Confluence is well visualized Gall bladder is normal in irregular in shape with thick wall. Multiple small signal void structures are seen within the lumen MPD is normal in course and diameter. No definite evidence of pancreatic divisum. NB. A cystic lesion is seen in the liver. Cysts are seen in both kidneys. Right sided hydronephrosis, abruptly narrowing at PUJ Impression: Findings suggest calculous cholecystitis with choledocholithiasis causing biliary obstruction. ERCP Report...... Procedure: E. R. C. P. with Stone Extraction Indication: Obstructive jaundice Medication: Under sedation FINDINGS: PAPILLA: is flanked by two diverticula. No bile flow seen. PANCREATOGRAM: Not attempted. CHOLANGIOGRAM: Selective cannulation could be done after needle papillotomy. The CBD, CHD and the intrahepatic ducts are grossly dilated. A fairly large rounded filling defect consistent with stone is seen in the distal CBD. Papillotomy is extended by conventional papillotome followed by large Balloon sphincteroplasty. Purulent pigment bile is seen coming out through the papilla. The stone is extracted out by grasping with dormia basket and left in to the duodenum. COMMENTS: Choledocholithiasis (Please see the description also). THERAPEUTIC INTERVENTION: Papillotomy and stone extraction done. Procedure performed by..................... Prof. Brig. Gen. Sk Md. Bahar Hussain (Retd.) MBBS,FCPS(Medicine),FRCP(Edin,Glasg),FACP(USA). Senior. Consultant & Interventional Gastroenterologist Department Of Gastroenterology. SQUARE Hospitals Ltd. For more videos please visit my youtube channel BD ENDOSCOPY / @bdendoscopy3663 #choledocholithiasis #ercp_stone_extraction #obstructive_jaundice #cbd_stone