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A "stitch in time"
1 Department of Clinical Medicine, St James’s Hospital, Dublin, Ireland
2 Department of Clinical Surgery, Trinity College and St James’s Hospital, Dublin, Ireland
Correspondence to:
Correspondence to Dr N Mahmud, Department of Clinical Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James’s Hospital, Dublin-8, Ireland; nmahmud@tcd.ie
| The first 150 words of the full text of this article appear below. |
A 68-year-old lady had presented 4 years previously with obstructive jaundice secondary to choledocholithiasis. Her only relevant history was a cholecystectomy in 1974. After sphincterotomy and mechanical lithotripsy, a balloon pull-through had cleared her common bile duct (fig 1). Despite this, recurrent choledocholithiasis and ascending cholangitis was necessitating endoscopic retrograde cholangiopancreatography (ERCP) every 3–4 months. Haematological and radiological investigation failed to reveal a cause for the recurrent stones and it was decided to manage her disease with repeated biliary stenting. During a stent change, 4 years after presentation, an unusual finding was discovered during endoscopy (fig 2).
Figure 1 A cholangiogram (endoscopic retrograde cholangiopancreatography) demonstrates two filling defects consistent with choledocholithiasis. The stones were successfully extracted endoscopically.
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Figure 2 An endoscopic view of the sphincterotimised ampulla.
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Question
What is the aetiology of the recurrent choledocholithiasis?
Answer
The image demonstrates a silk suture protruding through the Ampulla of Vater. Attempted manipulation of the
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