case_images: PMC4599162_01
case_images: CT of the abdomen and pelvis with oral contrast revealing abnormal lobulated contour and thickening of the gallbladder and cystic duct, with heterogeneous enhancement noted in the thickened gallbladder wall. Multiple peripherally dense intraluminal objects in the lumen representing gallstones.
case_images: bmjgast2015000046f01.jpg
case_images: PMC4599162_01_bmjgast2015000046f01.jpg
case_images: BMJGAST2015000046F1
case_images: A CT scan found an incidental nodule on the adrenal gland, but confirmed findings from the ultrasound (figure 1).
case_images: Cholangiogram revealing areas of filling defect of the common bile duct consistent with stones.
case_images: bmjgast2015000046f02.jpg
case_images: PMC4599162_01_bmjgast2015000046f02.jpg
case_images: BMJGAST2015000046F2
case_images: A cholangiogram was performed and showed evidence of filling defects consistent with common bile duct stones (figure 2).
case_images: Intraoperative view of major papilla.
case_images: bmjgast2015000046f03.jpg
case_images: PMC4599162_01_bmjgast2015000046f03.jpg
case_images: BMJGAST2015000046F3
case_images: After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
case_images: Intraoperative view of sphincterotomy.
case_images: bmjgast2015000046f04.jpg
case_images: PMC4599162_01_bmjgast2015000046f04.jpg
case_images: BMJGAST2015000046F4
case_images: After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
case_images: Pigmented stone removed during endoscopy.
case_images: bmjgast2015000046f05.jpg
case_images: PMC4599162_01_bmjgast2015000046f05.jpg
case_images: BMJGAST2015000046F5
case_images: After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
case_images: Cholesterol stone removed during endoscopy.
case_images: bmjgast2015000046f06.jpg
case_images: PMC4599162_01_bmjgast2015000046f06.jpg
case_images: BMJGAST2015000046F6
case_images: After the major papilla was identified (figure 3), a sphincterotomy was performed using a standard sphincterotome (figure 4) followed by balloon extraction of multiple pigmented and cholesterol stones (figures 5 and 6).
case_images: Occlusion cholangiogram showing successful removal of previously noted stones.
case_images: bmjgast2015000046f07.jpg
case_images: PMC4599162_01_bmjgast2015000046f07.jpg
case_images: BMJGAST2015000046F7
case_images: Repeat occlusion cholangiogram showed successful resolution of previously noted filling defects (figure 7).