Trans-ampullary Choledochoduodenal Fistula
82 year-old woman with chronic biliary obstruction caused by two large common bile duct stones. The distal common duct had spontaneously drained via a fistula across the ampullary wall and into the duodenum.
LEFT: The ampulla with cannula in place. Contrast injected through the cannula flows back into the duodenum through the fistula tract located on the side wall of the ampulla.
RIGHT: After papillotomy, the larger of the two common duct stones being extracted into the duodenum using the papillotome.
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