A 58-year-old woman underwent laparoscopic biliopancreatic diversion of the distal stomach in April 2007 due to morbid obesity.
The patient was admitted to the hospital with epigastric pain and right hypochondrium fever and jaundice.
The abdominal ultrasound and scan showed dilation of the intrahepatic bile duct and common bile duct, with a choledochal of 15 mm Ø, and a calculus within 10 mm Ø.
Endoscopic access to the papilla of Vater was not possible due to previous surgery.
We attempted to perform laparoscopically assisted ERCP to treat colitis.
The surgeon placed a 15 mm trocar in the greater curvature of the excluded stomach.
A therapeutic duodenum was used (TJF 145, Olympus, Tokio, Japan) with an external diameter of 12 mm, previously disinfected with 2% glutaraldehyde.
The endoscopist advanced the duodenoscope through the gastrostomy into the major papilla.
Discharge was achieved through deep cannulation of the main bile duct using a commonly used sphincterotome (FSOMNI, Wilson-C Medical, Winston-Salem, NC, USA).
The cholangiogram showed an intrahepatic and extrahepatic bile duct with a calculus of about 8 mm in the common bile duct.
A biliary sphincterotomy was performed, producing biliary tree depression.
Subsequently, calculi were fixed using a Fogarty balloon of 12-15-mm Ø (Extractor Rx.
Retrieval Balloon, Boston Scientific, Boston, MA, USA.
