An elusive case of endoscopic retrograde cholangiopancreatography: a case report

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic technique which combines endoscopy and fluoroscopy to treat many complications associated with biliary ductal systems. We present an elusive case of ERCP for choledocholithiasis where ERCP was unsuccessful due to the patient’s anatomic orientation. The patient is a 61-year-old Caucasian male who was admitted due to epigastric, right upper quadrant pain, and nausea. Abdominal imaging revealed at least 2 stones in the distal common bile duct. Upon evaluation his management plan included ERCP which was unsuccessful as the patient had a periampullary diverticulum making it difficult to visualize the ampulla. Ultimately, the next step in management was to follow up with laparoscopic cholecystectomy (LC) to alleviate the patient’s pain and symptoms. Postoperatively the patient is stable and doing well on follow up. The patient was referred to a tertiary care center for further management for postoperative ERCP. Although, the interventions attempted for this patient allowed him to become stable, the need for further advancements in ERCP must be established for patients who present with anatomical challenges in order to prevent repeated procedures as well as complications relating to delayed removal of gallstones.