case_images: PMC11760801_01
case_images: Axial section on Computed Tomography of Abdomen Pelvis (CTAP) showing cholelithiasis, peri-cholecystic oedema (A) and common bile duct diameter (B).
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case_images: A Computed tomography (CT) scan with Intravenous (IV) contrast was performed as part of the workup, which showed small calculi within gallbladder and evidence of pericholecystic oedema without gallbladder wall thickening (Fig. 1).
case_images: Initial ultrasound demonstrating non dilated proximal common bile duct. Limited view due to patient's body habitus.
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case_images: A subsequent transabdominal biliary ultrasound demonstrated a small volume of sludge, mobile cholelithiasis and a non-dilated proximal common bile duct (CBD) with a diameter of 5.2 mm (Fig. 2).
case_images: Endoscopic Retrograde Cholangiopancreatography (ERCP) image demonstrating clot at orifice pre-sphincterotomy.
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case_images: He subsequently underwent an emergency ERCP which demonstrated a large mid to distal CBD clot obstructing the orifice with CBD dilatation to 12 mm (Fig. 3, Fig. 4).