A 55 year old woman presented with
history of recurrent episodes of right
upper abdominal pain for the last one
year. She presented to emergency with
history of jaundice and fever for 2 days.
On examination, the patient appeared
toxic and had a blood pressure of
100/60 mmHg. She was started on
intravenous antibiotics. Ultrasound of
the abdomen showed presence of
stones in the common bile duct. What
would be the best treatment option for
her -
a) ERCP and bile duct stone extraction
b) Laparoscopic cholecystectomy
c) Open surgery and bile duct stone extraction
d) Lithotripsy
Correct Answer - A
Answer- A. ERCP and bile duct stone extraction
Methods of biliary decompression
a. ERCP with sphincterotomy and stone extraction
It is the procedure of choice,
Early endoscopy allows not only diagnosis by cholangiography and
direct visualization of the ampulla but also permits biliary
decompression by sphincterotomy and stone extraction.
If the stones cannot be removed, a nasobiliary catheter or stent is
inserted to decompress the biliary tract.
b. Percutaneous transhepatic route (PTC)
PTC is performed if
The endoscopic procedure has failed or not available.
If the obstruction is more proximal or perihilar.
If there is a stricture in a biliary enteric anastomosis.
c. Surgical biliary decompression