Transduodenal Ampullography: Extending Surgical Safety Near Pancreaticobiliary Junction.

Aim and background: The pancreaticobiliary junction (PBJ) is a complex anatomical location where the pancreatic duct and distal common bile duct (CBD) join. Surgical procedures near the PBJ are challenging, and inadvertent injury to either of these ducts can increase postoperative morbidity. Choledochal cyst (CDC) excision involves securing the distal bile duct near the PBJ. The surgical morbidity in these patients can be precipitated by improper closure of the distal biliary stump, causing pancreatic leak or intra-abdominal collections. In this report, we describe a novel technique - transduodenal ampullography (TAG), in securing the distal biliary stump during CDC excision, which can be used in special situations near the PBJ. Case description: A female in her mid-thirty with type I CDC was planned for CDC excision. While trying to excise the intrapancreatic portion of the CDC, the distal stump was accidentally transected and retracted into the pancreatic parenchyma. In order to avoid pancreatic leak, the distal stump was secured using TAG. Through a duodenotomy, the major papillary prominence was identified, and the ampulla was cannulated. The retracted distal stump was identified after injecting dye into the cannula in the ampulla. The identified distal stump was secured using interrupted sutures with a pancreatic stent Conclusion: Transduodenal ampullography is a safe, simple and feasible technique, which can be used to secure the intrapancreatic distal bile duct in special situations. Clinical significance: Surgical procedures near the PBJ are challenging and are associated with inherent morbidity due to their anatomical location.Transduodenal ampullography is a safe and feasible technique which can be used in special surgical situations near the PBJ. How to cite this article: Dasari M, Gurana KR, Sharma VK,