An 87-year-old man presented with obstructive jaundice was
admitted to the endoscopy unit. The patient has a history of ERCP 15 years ago
due to calcular obstructive jaundice, removing the stones, and inserting a
stent. The patient lab showed 8 mg/ dl bilirubin, which is direct, moderately
elevated transaminases, lymphopenia (may be COVID- 19), and a platelet count of
55000. The pelviabdominal ultrasonography and non-contrast CT showed a stone
1.2 cm at the duodenal end of CBD and liver cirrhosis. The patient underwent
ERCP. The scope revealed a stone at the tip of the duodenal ampulla.
Cannulation of the CBD led to the lodge of the stone into the interior of the
CBD. Cholangiogram showed a filling defect inside the CBD. Once the stone
passed inside the CBD, much pus was discharged, denoting cholangitis. An atrial
extraction of the stone with a basket was failed. Dilatation of the ampulla
using a sphincterotomy, then a balloon was successfully used to extract the stone.
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