Perforation of the Papilla of Vater in Wire-Guided Cannulation

Figure 3

(a) An 80-year-old man with no juxtapapillary duodenal diverticula underwent ERCP for obstructive jaundice that was induced by cancer of the head of the pancreas. Because of the invasion of pancreatic head cancer to duodenum, having a front view of a papilla of Vater is difficult. (b, c) WGC (S + 0.025-inch angle visiglide) was performed, but the wire made an extraluminal perforation, and extravasation of the contrast medium was observed during fluoroscopy (arrow). After PSP was performed with a pancreatic duct guidewire, deep cannulation of the bile duct and biliary drainage were achieved.

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(b)

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