Cholecystostomy-tube cholangiography guiding ERCP for bile duct stones after pancreaticoduodenectomy.

A 32-year-old woman presented with acute calculous cholecystitis and concomitant mild acute cholangitis four years after pylorus-preserving pancreaticoduodenectomy with gallbladder preservation. Initial non-contrast computed tomography showed biliary dilatation but no definite bile duct stone. Percutaneous cholecystostomy was performed for initial source control. After clinical improvement, cholangiography through the existing cholecystostomy tube demonstrated biliary filling defects and clarified the postoperative anatomy. Subsequent ERCP using a cap-fitted therapeutic colonoscope enabled successful cannulation of the choledochojejunostomy, limited balloon dilation, and complete basket extraction of soft, friable bile duct stones. This case illustrates how an existing cholecystostomy tract can facilitate diagnosis, anatomical mapping, and subsequent endoscopic treatment in selected patients with surgically altered anatomy.