case_images: PMC6186356_01
case_images: Abdominal ultrasound with filling defect in bile duct.
case_images: CRIHEP2018-4707389.001.jpg
case_images: PMC6186356_01_CRIHEP2018-4707389.001.jpg
case_images: fig1
case_images: Abdominal ultrasound showed no evidence of intrahepatic or extrahepatic biliary ductal dilatation but did note a linear filling defect within the common bile duct (CBD) as seen in Figure 1.
case_images: MRI/MRCP showing anastomotic biliary stricture, common hepatic ductal dilatation, and subtle curvilinear filling defect within the common hepatic duct.
case_images: CRIHEP2018-4707389.002.jpg
case_images: PMC6186356_01_CRIHEP2018-4707389.002.jpg
case_images: fig2
case_images: MRI/MRCP was thus performed, which was significant for an abrupt change in caliber at the biliary anastomosis consistent with stricture (ABS), dilatation of the common hepatic duct (CHD) to 7 mm, and a curvilinear filling defect at the level of the anastomosis (Figure 2).
case_images: (a) ERC showing black pediatric feeding tube with overlying biofilm protruding from the papilla. (b) ERC with successful extraction of black pediatric feeding tube from the papilla.
case_images: CRIHEP2018-4707389.003.jpg
case_images: PMC6186356_01_CRIHEP2018-4707389.003.jpg
case_images: fig3
case_images: The ABS was first balloon dilated to 6 mm followed by sweeping of the extrahepatic duct was performed with a 9 mm extraction balloon; this first yielded biliary sludge, but with additional sweeps, a 3.5 cm long, black tubular structure with overlying sludge/biofilm was extracted (Figures 3(a) and 3(b)).
case_images: Extracted pediatric feeding tube.
case_images: CRIHEP2018-4707389.004.jpg
case_images: PMC6186356_01_CRIHEP2018-4707389.004.jpg
case_images: fig4
case_images: This was grasped and brought out per os using forceps and appeared to be consistent with an oxidized pediatric feeding tube (Figure 4).