ERCP IN SEVERE CHOLANGITIS Today at 5:00pm, this 60 years male deeply jaundiced ( with s/bil=29 mg/dl) was referred to AREC/ LIVER CLINIC, 250 shadman, Lahore from surgical ward, JHL for urgent ERCP. During ERCP, seen that there was a bulbous ampulla with an abnormal tissue at ampullary orifice. The ampulla was lying distal to a duodenal diverticulum. On touching cannula to ampullary orifice, bleeding occurred, that stopped spontaneously. On cannulation of CBD, frank pus started coming out of CBD. After guide-wire cannulation, the contrast was injected. The CBD was grossly dilated with distal tapering, due to ampullary stenosis. Intrahepatic ducts were also grossly dilated. No stone or slugde seen in the CBD. So a plastic biliary stent of size 7cm X 10 0F passed over the guide wire into the CBD successfully, through which free flow of bile mixed with pus seen. Plan: Advised rehydration with 1 litre Normal saline on receiving patient back at hospital in addition to antibiotcs CT scan abdomen contrast Repeat CBC, LFTs, & Ultrasound after 2 weeks & follow. DR. MUHAMMAD IRFAN Assistant Professor of Medicine Endoscopist/ERCP Consultant
Posted on: Wed, 24 Dec 2014 17:57:45 +0000
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