ERCP Mirizzi综合征和肝脓肿

                               
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A 76 year old lady with many co-morbidities, including sickle cell trait, chronic lymphoedema (wheelchair bound) and chronic kidney disease had an ERCP a year ago because of cholangitis. A sphincterotomy was performed and the bile duct was trawled with a balloon catheter. A large stone was noted in the gallbladder but she did not have a cholecystectomy because of the co-morbidities. She now presents with jaundice (Bilirubin 136 umol/L, Alk Phosp 1500). The CT scan shows a 7cm liver abscess adjacent to a gallbladder empyema. In addition a stone in the gallbladder is pressing on the bile ducts causing dilatation of intrahepatic ducts (Mirizzi syndrome).
Treating this patient proved challenging… a further ERCP was performed as well as external drainage of the liver abscess (see video). Cholecystectomy pending...