case_images: PMC5292123_01
case_images: Preintervention MRCP revealing a fluid collection in continuity with the cystic duct representative of a contained bile leak (marked with arrow).
case_images: CRIGM2017-1710501.001.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.001.jpg
case_images: fig1
case_images: U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
case_images: Preintervention MRCP revealing a nine-millimeter stone in the cystic duct (marked with arrow).
case_images: CRIGM2017-1710501.002.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.002.jpg
case_images: fig2
case_images: U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
case_images: ERCP revealing a stone in the cystic duct (marked with arrow).
case_images: CRIGM2017-1710501.003.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.003.jpg
case_images: fig3
case_images: U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
case_images: ERCP revealing proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak in this patient with a history of cholecystectomy. The contained bile leak is marked with an arrow.
case_images: CRIGM2017-1710501.004.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.004.jpg
case_images: fig4
case_images: U/L, aspartate aminotransferase (AST) 316 U/L, and alanine aminotransferase (ALT) 394 U/L, and magnetic resonance cholangiopancreatography (MRCP) revealed a fluid collection in continuity with the cystic duct and a nine-millimeter stone at the confluence of the cystic and common hepatic duct, resulting in both biliary and cystic duct dilatation with adjacent inflammation (Figures 1 and 2). Using ERCP, the cystic duct was cannulated and a filling defect consistent with a nine-millimeter stone was confirmed, along with proximal cystic duct dilatation and extravasation of contrast suggestive of a contained bile leak (Figures 3 and 4).
case_images: Nine-millimeter cystic duct stone visualized using peroral cholangioscopy.
case_images: CRIGM2017-1710501.005.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.005.jpg
case_images: fig5
case_images: The 10 Fr SpyGlass cholangioscope measuring 250 cm in length was then used to directly visualize the stone in the cystic duct (Figure 5). The visualized stone was irrigated using saline prior to EHL, which was achieved using a Nortech Autolith system (Northgate Technologies Inc.; Elgin, IL) and a 1.9 Fr EHL probe.
case_images: Occlusion cholangiogram after cystic duct stone removal.
case_images: CRIGM2017-1710501.006.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.006.jpg
case_images: fig6
case_images: Subsequent balloon sweeps of the cystic duct successfully cleared stone fragments (Figure 6) and repeat MRCP (Figure 7) one year after hospital discharge revealed no evidence of fluid collection or stone in the cystic duct.
case_images: Postintervention MRCP revealing stone extraction and resolution of previously seen fluid collection.
case_images: CRIGM2017-1710501.007.jpg
case_images: PMC5292123_01_CRIGM2017-1710501.007.jpg
case_images: fig7
case_images: Subsequent balloon sweeps of the cystic duct successfully cleared stone fragments (Figure 6) and repeat MRCP (Figure 7) one year after hospital discharge revealed no evidence of fluid collection or stone in the cystic duct.