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Silent migration: unexpected finding at ERCP
  1. Sreelakshmi Kotha,
  2. Terry Wong,
  3. Philip Berry
  1. Department of Gastroenterology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Sreelakshmi Kotha,Guy's and Saint Thomas' Hospitals NHS Trust, London, UK; sreelakshmi_kotha{at}yahoo.com

https://doi.org/10.1136/flgastro-2019-101212

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    An elderly patient with a history of laparoscopic cholecystectomy presented with recurrent abdominal pain. Imaging revealed a dilated common bile duct (CBD) with filling defects. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated multiple linear metallic clips with a halo of calculus material (figure 1). Attempts at removing the clips following a 10 mm sphincteroplasty resulted in horizontal impaction of clips beneath the trawling balloon (figure 2), increasing the risk …

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    Footnotes

    • Contributors SK: involved in patient care in outpatient and inpatient setting, performed endoscopic retrograde cholangiopancreatography (ERCP); involved in writing the manuscript. TW: involved in patient care in outpatient and inpatient setting, performed ERCP, involved in writing the manuscript. PB: involved in patient care in outpatient and inpatient setting, performed ERCP, involved in writing and revising the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

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