Peroral Cholangioscopy: Removal of Foreign Body From Biliary Tree
Comments: This is a 30 years old patient with history of abdominal gunshot wound about 5 years ago, who was admitted with recurrent abdominal pain and elevated liver enzymes. Scout film showed a foreign body near hepatic duct bifurcation. The extrahepatic biliary tree was diffusely narrowed. A dominant Hilar stricture was seen at the site of foreign body with upstream intrahepatic biliary dilation. The foreign body appeared to the move after balloon dilation. Patient was referred for CT abdomen to evaluate the location of foreign body. It showed metallic artifact in the region of porta hepatis, limiting complete evaluation. Due to persistent abdominal pain elevated liver enzymes, patient was referred back for repeat ERCP with oral choledochoscopy. Movement of the foreign body was seen fluoroscopically with advancement of the oral choledochoscope. Visualization of the biliary tree showed a fibrous stricture in mid-CBD. A black metallic object consistent with bullet was seen near hepatic duct bifurcation. A waist was still seen with 10 mm balloon dilation of the stricture. A 10mm covered metal stent was placed to progressively dilate the stricture and allow endoscopic removal of the bullet in two weeks. However the patient developed abdominal pain and x-ray showed bullet impacted inside the narrowed part of the biliary stent. The biliary stricture was dilated with 10 mm balloon. The metal stent was removed by a snare. The bullet was successfully removed from the biliary tree using a lithotripsy basket. A retrieval net was then used to remove it from the duodenum. A temporary 10 Fr plastic stent was then placed across the biliary stricture. A persistent improvement in the clinical and biochemical status of the patient was noted.
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Shahzad Iqbal, MD Columbia University Medical Center |
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Citation: Iqbal, S. (Jun 01 2009). Peroral Cholangioscopy: Removal of Foreign Body From Biliary Tree. The DAVE Project. Retrieved Sep, 2, 2010, from http://daveproject.org/viewfilms.cfm?film_id=857 Times viewed since Feb 2006: 3004 |
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