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With the virtue of Allah a patient rescued by rarely unsurgical operation at the Saudi German Hospital – Medina
2006-01-03
A 75 years old male patient presented to the hospital with jaundice, which proved to be due to very tight stricture at the lower end of the common bile duct. A previous attempt at endoscopic stenting was not possible because of the marked narrowing of common bile duct.
Under general anesthesia using fine needle the right intra hepatic biliary radicles were punctured and a colangiogram was done (PTC) and showed dilatation of the intrahepatic radicle with moderate dilatation of the extra hepatic part till the lower end of the common bile duct where a tight stricture with an irregular outline was noticed and no contrast be visualized passing to the 2nd part of the duodenum. A giude wire was introduced through the canula of the PTC to pass through the stricture in the lower CBD in the duodenum. At this stage of the procedure while the proximal part of the guide wire is at the mid axillary line outside patientzxc s skin and the distal part in the duodenum, it became possible for the endoscopy to come down to the duodenum and catch the end of the guide wire and ride over it to dilated the stricture in the lower CBD and insert a stent through the stenotic lower end of the common bile duct; what we call the randez-vous technique, which allowed the bile to pass freely in the duodenum.
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