The incidence of biliary stones is higher in the female sex [1]
[2]. Common bile duct (CBD) stones are the most common cause of acute biliary pancreatitis
(ABP) [3]. We report the case of a 39-year-old woman with ABP.
The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with an
initial approach to the minor papilla, which looked like the major papilla. During
ERCP we observed an impacted biliary stone in the papilla ([Fig. 1]; [Video 1]). Pre-cut was performed resulting in spontaneous stone expulsion, but it was not
possible to gain access to the CBD. The contrast medium injection revealed a dilated
Santorini duct originating from the cut papilla. The junction between the Santorini
and the Wirsung duct was far from the minor papilla, in the 3 rd duodenal portion,
with an abnormal biliopancreatic junction, and an uncommon intramural channel > 15 mm
([Fig. 2]).
Fig. 1 The impacted biliary stone in the minor papilla.
Video 1 The “inverted rendezvous” and major papilla septotomy to gain access to the common
bile duct, followed by endoscopic biliary sphincterotomy and retrieval of multiple
stone fragments.
Fig. 2 Radiographic features of the pancreatobiliary junction far from the minor papilla,
in the 3 rd duodenal portion, with an uncommon intramural channel.
After pancreatography, a wire was advanced into the Santorini duct, through the Wirsung
duct, to the duodenum, across the major papilla. After the “inverted rendezvous,”
a septotomy was performed, which enabled CBD access, and then endoscopic biliary sphincterotomy
(EBS) was performed. The cholangiography showed a 10 mm diameter CBD with multiple
fragmented stones in the distal portion. The fragments were extracted using a Dormia
basket, and a 7 Fr × 5 cm pancreatic plastic stent was placed for the prevention of
post-ERCP acute pancreatitis ([Video 1]).
Endoscopy_UCTN_Code_TTT_1AR_2AH
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
