A 91 year old well preserved lady presented with two recent episodes of jaundice +/- cholangitis. MRCP showed several stones in the gall bladder and two further stones in the CBD. She was therefore referred for an ERCP. Sixty three years ago, she had a partial gastrectomy for duodenal ulcer. Unfortunately for me, the operation was a Polya gastrectomy (Billroth II). This operation is not seen very often these days but always makes life difficult at ERCP because the papilla is approached from below and appears “upside down.” The attached video shows the ERCP.
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