PMC4599162_01
CT of the abdomen and pelvis with oral contrast revealing abnormal lobulated contour and thickening of the gallbladder and cystic duct, with heterogeneous enhancement noted in the thickened gallbladder wall. Multiple peripherally dense intraluminal objects in the lumen representing gallstones.
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A CT scan found an incidental nodule on the adrenal gland, but confirmed findings from the ultrasound (figure 1).
Cholangiogram revealing areas of filling defect of the common bile duct consistent with stones.
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A cholangiogram was performed and showed evidence of filling defects consistent with common bile duct stones (figure 2).
Intraoperative view of major papilla.
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After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
Intraoperative view of sphincterotomy.
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After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
Pigmented stone removed during endoscopy.
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After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
Cholesterol stone removed during endoscopy.
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After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
Occlusion cholangiogram showing successful removal of previously noted stones.
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Repeat occlusion cholangiogram showed successful resolution of previously noted filling defects (figure 7).