PMC6186356_01
Abdominal ultrasound with filling defect in bile duct.
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Abdominal ultrasound showed no evidence of intrahepatic or extrahepatic biliary ductal dilatation but did note a linear filling defect within the common bile duct (CBD) as seen in Figure 1.
MRI/MRCP showing anastomotic biliary stricture, common hepatic ductal dilatation, and subtle curvilinear filling defect within the common hepatic duct.
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MRI/MRCP was thus performed, which was significant for an abrupt change in caliber at the biliary anastomosis consistent with stricture (ABS), dilatation of the common hepatic duct (CHD) to 7 mm, and a curvilinear filling defect at the level of the anastomosis (Figure 2).
(a) ERC showing black pediatric feeding tube with overlying biofilm protruding from the papilla. (b) ERC with successful extraction of black pediatric feeding tube from the papilla.
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The ABS was first balloon dilated to 6 mm followed by sweeping of the extrahepatic duct was performed with a 9 mm extraction balloon; this first yielded biliary sludge, but with additional sweeps, a 3.5 cm long, black tubular structure with overlying sludge/biofilm was extracted (Figures 3(a) and 3(b)).
Extracted pediatric feeding tube.
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This was grasped and brought out per os using forceps and appeared to be consistent with an oxidized pediatric feeding tube (Figure 4).