evaluation after a severe colic
attack in obstructive jaandice secondary
to gall bladder stones. Before reaching
the papilla with the duodenoscope a supra-
papillary lesion of the mucosa is viewed.
Injection of contrast medium demonstrates
a connection to the bile duct. A submucous
fistula is depicted.
The origin of this fistula was a prepapillary
stone perforation from the intramural part
of the bile duct to the juxtapaillary region
of the duodenum.
- Katheterspitze = tip of catheter