PMC5292123_01
Preintervention MRCP revealing a fluid collection in continuity with the cystic duct representative of a contained bile leak (marked with arrow).
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fig1
U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
Preintervention MRCP revealing a nine-millimeter stone in the cystic duct (marked with arrow).
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fig2
U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
ERCP revealing a stone in the cystic duct (marked with arrow).
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fig3
U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
ERCP revealing proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak in this patient with a history of cholecystectomy. The contained bile leak is marked with an arrow.
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fig4
U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
Nine-millimeter cystic duct stone visualized using peroral cholangioscopy.
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fig5
The 10 Fr SpyGlass cholangioscope measuring 250 cm in length was then used to directly visualize the stone in the cystic duct (Figure 5). The visualized stone was irrigated using saline prior to EHL, which was achieved using a Nortech Autolith system (Northgate Technologies Inc.; Elgin, IL) and a 1.9 Fr EHL probe.
Occlusion cholangiogram after cystic duct stone removal.
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Subsequent balloon sweeps of the cystic duct successfully cleared stone fragments (Figure 6) and repeat MRCP (Figure 7) one year after hospital discharge revealed no evidence of fluid collection or stone in the cystic duct.
Postintervention MRCP revealing stone extraction and resolution of previously seen fluid collection.
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fig7
Subsequent balloon sweeps of the cystic duct successfully cleared stone fragments (Figure 6) and repeat MRCP (Figure 7) one year after hospital discharge revealed no evidence of fluid collection or stone in the cystic duct.