Difficulties of endoscopic retrograde cholangiography after an atypical billroth ii resection

Introduction: ERCP after Billroth II gastrectomy is rarely performed and technically more difficult procedure than with normal anatomy. We have to prepare for unexpected events and changes if needed to reach the therapeutic aim. Case study: ERCP was planned to perform in a 57 year-old female patient who complained r.u.q. abdominal pain and clinical signs of jaundice. One year before she had an atypical Billroth II resection (very small gastric stump left) because of a pT3pN2, anaplastic sigillocellular carcinoma. According to the histopathological evaluation it proved to be adenocarcinoma, with the signs of lini…