case_images: PMC11800723_01
case_images: Non-contrast MRI images of recurrent hepatocellular carcinoma. There is a 17 mm hepatocellular carcinoma (white arrow) in segment IV of the liver, which shows high signal intensity on fat-suppressed T2-weighted images and diffusion-weighted images, with the signal decreasing from in-phase to out-of-phase. (a) Fat-sat T2-weighted image; (b) Diffusion-weighted image; (c) T1-weighted in-phase image; (d) T1-weighted out-of-phase image.
case_images: cureus-0017-00000077072-i01.jpg
case_images: PMC11800723_01_cureus-0017-00000077072-i01.jpg
case_images: FIG1
case_images: Most recently, she underwent RFA four months ago for a 17-mm recurrent HCC in the same liver segment (Figure 1).
case_images: Magnetic resonance cholangiopancreatography image reveals a stricture (white arrow) in the left hepatic duct, accompanied by dilation of the peripheral bile ducts (B2 and B3).
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case_images: PMC11800723_01_cureus-0017-00000077072-i02.jpg
case_images: FIG2
case_images: Magnetic resonance cholangiopancreatography showed a stricture in the left hepatic duct with peripheral ductal dilation (Figure 2).
case_images: Images obtained during endoscopic ultrasound-guided hepaticogastrostomy. (a) The dilated left intrahepatic bile duct (white arrow) was visualized using an ultrasound endoscope from the stomach. (b) The dilated left intrahepatic bile duct was punctured under endoscopic ultrasound guidance. (c) A guidewire (black arrow) was inserted into the bile duct and advanced beyond the duodenal papilla into the duodenal lumen. (d) An additional guidewire was advanced into the bile duct, and a plastic stent (white arrowhead) was inserted transgastrically into the bile duct, with one guidewire left in place. (e) A plastic stent (white arrowhead) was deployed from the stomach into the bile duct, successfully completing endoscopic ultrasound-guided hepaticogastrostomy.
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case_images: PMC11800723_01_cureus-0017-00000077072-i03.jpg
case_images: FIG3
case_images: Scientific, Marlborough, MA, USA), was inserted through the catheter. Subsequently, the first biliary plastic stent, a 7Fr, 14-cm Through & Pass TYPE IT stent (Gadelius Medical, Tokyo, Japan), was placed with its tip positioned in the extrahepatic bile duct (Figure 3).
case_images: Images of transpapillary inside stent placement performed using the rendezvous method after ultrasound-guided hepaticogastrostomy.. (a) The scope was advanced to the descending part of the duodenum, and the guidewire protruding from the duodenal papilla was confirmed. (b) The bile duct was accessed using a rendezvous technique using a guidewire. (c) An inside stent was deployed transpapillary to cross the stricture in the bile duct, completing the procedure.
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case_images: FIG4
case_images: Utilizing the guidewire extending from the duodenal papilla into the duodenal lumen, a 7Fr, 12-cm Through & Pass-inside deep-angle stent was positioned above the papilla, successfully crossing the biliary stricture (Figure 4).