PMC6119204_01
(A) Purulent discharge from above the major papilla. (B) Stone concealing the choledochoduodenal fistula. (C) Exposed choledochoduodenal fistula (white arrow) with edematous papilla (black arrow).
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F1
A same-day ERCP demonstrated an edematous major papilla with bilious and purulent discharge from above the major papilla orifice, determined to be the site of a CDF (Figure 1).
Inflated balloon through choledochoduodenal fistula prior to sphincterotomy.
CG-CGCR180048F002.jpg
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F2
A generous biliary sphincterotomy was made with an extension close to the adjacent horizontal duodenal fold, connecting the major papillary opening to the fistula, and large balloon papillary dilation to 11 mm was performed (Figure 2).