PMC4748201_01
Abdominal/pelvic CT showing cholelithiasis, choledocholithiasis, intra- and extrahepatic biliary ductal dilatation.
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F1
Abdominal/pelvic computed tomography (CT) without contrast showed extensive cholelithiasis and choledocholithiasis resulting in intra- and extrahepatic biliary ductal dilatation; the CBD measured 1.4 cm (Figure 1).
ERCP showing bile duct and pancreatic duct access via the choledochoduodenal fistula.
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F2
The stones naturally flowed distally and a balloon was placed above to sweep them down to the native ampulla (Figure 2).
Native ampulla bulging and stretching the stenosis.
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F3
This stretching allowed for both the bile duct and pancreatic duct to be accessed via the native ampulla (Figure 3).
Traditional sphincterotomy and removal of stones.
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F4
A traditional sphincterotomy was performed and the stones were removed (Figure 4).