common bile duct stone noted and removed with the endoscopic retrograde cholangiopancreatography

INDICATIONS:                                             Abdominal pain with the common bile duct stone seen on CT imaging with abnormal liver enzymes.  Symptoms compatible with common bile duct stones.

POSTPROCEDURE DIAGNOSES:        1.  Single common bile duct stone noted and removed with the endoscopic retrograde cholangiopancreatography, sphincterotomy, and stone extraction.

                                                                        2.  Possible gallstones.  This is pending review by the radiologist.

PROCEDURE IN DETAIL:                                                The risks of perforation, bleeding, infection, sedation, and pancreatitis were outlined in detail, and also delineated in the history and physical and consult.  Anesthesia facilitated intubation and sedation in the prone position.  Once in this position and sedated and intubated, the scope easily advanced to the second portion of the duodenum where the major ampulla is identified.  Initial cannulation resulted in pancreatic cannulation.  Manipulation with the wire resulted in subsequent easy biliary cannulation, which identified a small stone in the distal bile duct.  There was also possible filling defects within the gallbladder itself.  This will be reviewed with the radiologist.  The sphincterotomy was then undertaken with 9- to 12-mm balloon, sweeping out the stone. This was seen within the duodenum and photographed.  Further extraction cholangiography revealed no other filling defects in the common bile duct or intrahepatic biliary tree beside from bubbles.  Free drainage was noted with postprocedure imaging, identifying good biliary drainage.  The patient will be observed, placed on liquids.  Surgical discretion at the timing of cholecystectomy, morning labs to be followed up.  She did receive antibiotics earlier today.