This 89 lady status post multiple DACP and EHL sessions for giant choledocholithiasis is referred with recurrent abdominal pain and an increase in liver function tests. Cholangiogram demonstrates intraluminal filling defects and a balloon catheter is used to sweep sludge from the distal common bile duct. Because of the caliber of the common bile duct, and air trapping on the right side, a cholangiogram could not rule out the possibility of persistent stone disease. Therefore, DACP was performed. The common bile duct was capacious, but the DACP exam demonstrated complete clearance of stone debris.
Brenna C. Bounds, M.D., Harvard Medical School, Massachusetts General Hospital