Percutaneous biliary internal decompression in a patient with simultaneous malignant biliary and duodenal obstruction and surgically modified anatomy.

Simultaneous involvement and obstruction of the common bile duct and the duodenum presents a difficult and challenging problem to the surgeon, the endoscopist and the interventional radiologist. In the case report we present here, the patient had had duodenal and biliary obstruction secondary to hepatic flexure adenocarcinoma and presented with recurrent obstructive jaundice. As the surgically modified anatomy precluded all conventional endoscopic and percutaneous approaches, it was necessary to use an improvised method of achieving biliary decompression.