Placement of a biliary metal stent to expand a choledochus stenosis after Frey's surgery

A 47-year-old patient presented with jaundice. Laboratory examinations confirmed cholestasis. The patient had a long history of chronic pancreatitis. Subsequently, cholecystectomy and a duodenumpreserving resection of the pancreatic head (Frey's surgery) had been performed. Endoscopic retrograd holangiography was done. The endoscope was inserted the normal way to the untouched papilla vateri. After injection of contrast medium, only the side-to-side choledocho-jejunal anastomosis but not the common bile duct could be visualized because the catheter spontaneously slipped into the jejunum via the side-to-side choledocho-jejunal anastomosis. After introducing a catheter percutaneously into the intrahepatic bile duct system, a long stenosis of the common bile duct could be visualized. It was possible to overcome the stenosis with a wire, but the wire also dislocated into the jejunum via the side-to-side choledocho-jejunal anastomosis and could not be placed through the papilla into the duodenum. The problem was solved in a tricky way: A wire was introduced into the common bile duct via the papilla and placed into the duodenum. A loop was brought in percutaneously and was also placed in the jejunum. With the loop, the wire was grabbed and taken out percutaneously. Now a biliary metal stent could be positioned correctly over the wire to expand the stenosis. After the procedure jaundice was cured quickly. The further course was uneventful with complete recovery. (c) 2006 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.