Gall Bladder Obstruction CBD_002

Sections have been taken before and in two phases following intravenous contrast. There is gross dilatation of all the intrahepatic bile ducts with massive dilatation of the extrahepatic bile ducts as far as the distal CBD. This implies a lesion in the region of the ampulla. There is no evidence of bile duct calculi. There is secondary obstruction of the pancreatic duct. No hepatic metastatic disease is identified and the spleen and kidneys are unremarkable. CONCLUSIONS: Obstructive jaundice appears to be caused by a focal ampullary lesion which has not been resolved on this scan.

Radiological Report : Percutaneous Transhepatic Cholangiogram :

Following informed consent and with 5mls of 1% Lignocaine a fluoroscopy guided puncture was made in the right mid axillary line. Intercostal approach. Cholangiogram confirmed high grade obstruction to the distal CBD with tapering in keeping with malignant obstruction. No gallstones. The obstruction was crossed with a wire and catheter combination. 6 French sheath. 8mm, 8cm metal stent. Initial deployment demonstrated a mid stent stenosis, which was ballooned to 8mm with satisfactory appearance. Free drainage of contrast. No complications. No covering drain.