A 32-year-old woman underwent laparoscopic cholecystectomy two days following a transient episode of mild gallstone pancreatitis. The table was rolled 20 degrees to the right, and intraoperative cholangiogram was performed using 25% iodinated contrast, injecting 7 cc without pressure under C-arm fluoroscopy. Four 4 mm stones (the duct was measured at 6 mm by pre-operative ultrasound) were identified in the duct. One mg of glucagon was given intravenously, and the duct was gently flushed with saline under fluoroscopic guidance, but the stones could not be flushed out of the common duct.
There was a slow trickle of contrast past the stone lodged at the ampulla, and contrast can be seen in the duodenum on this completion view. No further common duct manipulation was performed, and the cholecystectomy was completed.
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