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Endoscopy
Inside view
The ‘pig’s snout’ appearance during intraoperative cholangioscopy
  1. Kunal Rajput,
  2. Alberto Martinez Isla
  1. Upper GI Surgery, London North West University Healthcare NHS Trust, Harrow, Middlesex, UK
  1. Correspondence to Mr Kunal Rajput; kunal.rajput{at}doctors.org.uk

https://doi.org/10.1136/flgastro-2024-102669

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    Introduction

    A 39-year-old female patient presented to the upper gastrointestinal outpatient clinic with a protracted history of recurrent right upper quadrant pain. She was otherwise fit and well, with a body mass index of 30 and no previous operations. On physical examination, she was not clinically jaundiced and had abdominal tenderness in the right upper quadrant region on palpation. Liver function tests revealed a cholestatic picture with a bilirubin of 44 µmol/L (0–20 µmol/L), alanine aminotransferase of 613 U/L (10–35 U/L) and alkaline phosphatase of 281 U/L (30–130 U/L). Radiological imaging, including ultrasound and magnetic resonance cholangiopancreatography (MRCP), confirmed a fusiform dilatation of the common bile duct (CBD), left hepatic duct and first-order branch intrahepatic ducts, along with the presence of three calculi within the CBD, largest measuring 20 mm. Her management involved laparoscopic cholecystectomy, choledochotomy …

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    Footnotes

    • Contributors KR and AMI were involved in study conception, design, video editing and manuscript preparation.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.