Post written by Jorge Vargas, MD, from the Social Security System of Costa Rica, Hospital of Liberia, Guanacaste, Costa Rica.

During a regular ERCP, a forceful stone extraction of a big stone was performed, and a frightening complication occurred. The common bile duct prolapsed into the duodenal lumen. After several cannulation attempts, we were able to cannulate the prolapsed duct and negotiate a guidewire into the proximal biliary tree. To evaluate the severity of the situation, we did an occlusive cholangiogram in which we noticed a disruption of the CBD. We decided to place a FC-SEMS to control the adverse event. The patient did well, and after 12 weeks we removed the SEMS, with evidence of restoration of the CBD.

It is very impressive to see the bile duct prolapsed into the duodenal lumen. It also demonstrates a rare complication associated with ERCP and shows a possible solution to this scary complication. Do not try this at home (a forceful stone extraction) to prevent this type of complication. In cases of large stones, first try DASE or intraductal lithotripsy. Second and most important, complications are part of procedures, most of them can be managed endoscopically. KEEP CALM AND TRY TO SOLVE YOUR COMPLICATION.

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