PMC5421083_01
Black esophagus on endoscopy.
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There were no varices, ulcerations, or other causes of bleeding (Figure 1).
Endoscopic Retrograde Cholangiopancreaticogram showing sclerosing cholangitis.
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ERCP showed cholelithiasis and choledocholithiasis and balloon occlusion cholangiogram suggested sclerosing cholangitis (Figure 2).
Endoscopic visualization of necrotic biliary cast.
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ERCP confirmed secondary sclerosing cholangitis and several biliary casts could be extracted by balloon sweeping of the biliary tree (Figure 3). Eight months after presentation he developed large volume ascites treated with diuretics.