Choledocholithiasis - stone extraction through a diverticulum.A 78 year old male presented with abdominal pain, abnormal bilirubin and alkaline phosphatase and a CT suggesting an ampullary mass. At ERCP, the papilla was noted to be in a large diverticulum (top left and center). Contrast was injected into the biliary tree using a bowed papillotome (top right). This revealed a large stone and dilated extra and intrahepatic ducts (bottom left). A sphincterotomy was performed. Following this, a lithotriptor was inserted into the duct and a large stone snared (bottom right).
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