PMC5519400_01
CT scan showing distended gallbladder (arrow) and inflammatory changes within the adjacent fat, suggestive of acute cholecystitis.
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F1
An abdominal computed tomography scan also showed a distended gallbladder with thickened walls and inflammatory changes within the adjacent fat, along with cholelithiasis and a dilated CBD (Figure 1).
ERCP image showing obstructed cystic duct with multiple filling defects in the CBD.
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F2
The patient was started on intravenous hydration and empiric antibiotics, and soon after underwent endoscopic retrograde cholangiopancreatography (ERCP), which showed an obstructed cystic duct and multiple CBD stones (Figure 2).
Percutaneous cholangiogram showing gallbladder and CBD stones.
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F3
She underwent multiple evaluations and exchanges of the PC tube by interventional radiology, and percutaneous cholangiograms showed a patent cystic duct and occluded biliary stent with some contrast reaching the duodenum (Figure 3).
(A) Gallstone retrieval under direct visualization using Roth net retriever. (B) One of the extracted gallstones in a retrieval basket.
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F4
Lithotripsy was successful, and the gallstones were removed using a variety of techniques, including a Roth net and a retrieval basket (Figure 4).
Percutaneous cholangiogram following the procedure showing contrast flow into the duodenum with no significant obstruction.
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F5
A week later, a percutaneous cholangiogram showed contrast flow into the duodenum with no significant obstruction (Figure 5).