PMC4435381_01
Cholangiography demonstrates a fistulous connection of extrahepatic biliary system and duodenum (arrows).
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F1
A small fistula was noted by contrast fluoroscopy, extending between proximal biliary tree/porta hepatis and the duodenal bulb, likely secondary to previous chemotherapy and radiation and liver metastasis (Figures 1 and 2).
Deep biliary cannulation from the duodenal bulb, through the fistula (arrow), and into the deep left intrahepatic system.
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F2
A small fistula was noted by contrast fluoroscopy, extending between proximal biliary tree/porta hepatis and the duodenal bulb, likely secondary to previous chemotherapy and radiation and liver metastasis (Figures 1 and 2).
Endoscopic view of the biliary stent in good position in duodenal bulb.
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F3
This fistula was used to access the intrahepatic biliary system with an 0.035 guidewire (Jagwire; Boston Scientific, Natick, MA), whereupon a 7 French x 7 cm stent was placed in the fistula for palliation using a 9-mm upper scope and a standard introducer (Figures 3 and 4).
ERCP view of the biliary stent in the fistula connecting the deep left intrahepatic system and duodenal bulb (arrow).
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F4
This fistula was used to access the intrahepatic biliary system with an 0.035 guidewire (Jagwire; Boston Scientific, Natick, MA), whereupon a 7 French x 7 cm stent was placed in the fistula for palliation using a 9-mm upper scope and a standard introducer (Figures 3 and 4).