Here are the results of the Endoscopic Ultrasound (EUS):
- Normal pancreas
- Gallbladder wall thickening and gallstone that measured 8 mm in greatest dimension. It was hyperechoic and characterized by shadowing.
- Extra hepatic biliary tree dilation to 1cm with 5mm gallstone visualized in the distal common bile duct.
Here are the results of the Endoscopic Retrograde Cholangiopancreatography (ERCP):
There was brisk flow of contrast through the ducts. Image quality was excellent. Contrast extended to the entire biliary tree. There were small stones and sludge in the distal common bile duct, with mild upstream dilation of the extra hepatic bile duct. The cystic duct and gallbladder filled, revealing a gallstone.
– Sphincterotomy performed, balloon sweep of the biliary tree was done with removal of two 5mm CBD stones along with sludge. A 7 x 7 cm Fr plastic biliary stent was placed with good drainage of bile noted at the end of the procedure.
Hospital Course:
This patient’s pain and jaundice rapidly improved after ERCP. He was discharged the following day with plan to complete a 7-day course of antibiotics. He was given close follow up in 2 weeks with general surgery to plan for cholecystectomy as an outpatient.
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Case 6 Index:
Introduction
Physical Exam
Differential Diagnosis
Diagnostic Testing
Management
GI SIM 