case_images: PMC5688253_01
case_images: CT scans in Case 1. (a) Small stones or sludge were not detected in the biliary tract before administration of CTRX. (b) (Left, axial view; right, coronal view) small stones and sludge appeared in the gallbladder (long arrows) and common bile duct (short arrow) 3 days after ending CTRX administration. (c) The small stones and sludge disappeared after 4 weeks.
case_images: CRIM2017-3835825.001.jpg
case_images: PMC5688253_01_CRIM2017-3835825.001.jpg
case_images: fig1
case_images: CT scan revealed small stones and sludge in the gallbladder and common bile duct, which had not been detected in the CT scan on admission (Figures 1 and 1). CT scan after 4 weeks revealed disappearance of the small stones and sludge in the gallbladder and common bile duct (Figure 1), and the biliary stent was withdrawn the following day.
case_images: Endoscopic views before (a) and after (b) ERBD in Case 1. (a) Absence of bile excretion from the ampulla of Vater indicated bile congestion by common bile duct obstruction. (b) Insertion of biliary stent resulted in excretion of the bile.
case_images: CRIM2017-3835825.002.jpg
case_images: PMC5688253_01_CRIM2017-3835825.002.jpg
case_images: fig2
case_images: Endoscopic retrograde cholangiography (ERC) demonstrated the absence of bile excretion from the ampulla of Vater, indicating bile congestion by obstruction of the common bile duct (Figure 2). Endoscopic retrograde biliary drainage (ERBD) by inserting a biliary stent resulted in excretion of the bile (Figure 2), and cholangitis resolved after the procedure.
case_images: PMC5688253_02
case_images: CT scans in Case 2. (a) Small stones or sludge were not detected in the biliary tract before administration of CTRX. (b) (Left, axial view; right, coronal view) small stones and sludge appeared in the gallbladder (long arrows) and common bile duct (short arrow) 10 days after ending CTRX administration.
case_images: CRIM2017-3835825.003.jpg
case_images: PMC5688253_02_CRIM2017-3835825.003.jpg
case_images: fig3
case_images: CRP (1.42 mg/dL), mild liver dysfunction (AST 47 U/L, ALT 18 U/L, LDH 235 U/L, ALP 233 U/L, gamma-GTP 73 U/L, total bilirubin 0.5 mg/dL), and elevations of serum amylase (938 U/L) and lipase (4113 U/L, RR: 12-52). CT scan revealed small stones and sludge in the gallbladder and common bile duct, which had not been detected two weeks earlier (Figure 3).
case_images: Endoscopic views before (a) and after (b) EST and ERBD in Case 2. (a) Deposition of white sludge and absence of bile excretion were seen on the ampulla of Vater. (b) EST and ERBD led to excretion of the bile.
case_images: CRIM2017-3835825.004.jpg
case_images: PMC5688253_02_CRIM2017-3835825.004.jpg
case_images: fig4
case_images: ERC showed deposition of white sludge on the ampulla of Vater and absence of bile excretion (Figure 4). Endoscopic sphincterotomy (EST) and ERBD were performed, resulting in excretion of the bile (Figure 4) and resolution of the abdominal pain.