A swirl ERCP during combined endoscopic-radiological-surgical management of a late-onset post-traumatic obstructive jaundice

A 47-year-old man suffered diaphragmatic laceration in a road trauma around the age of 30, with associated thoracic herniation of the right colon and part of the duodenum, atelectasis of the right lower lung lobe with median dislocation of the liver, atrophy of the right liver lobe, and compensatory hypertrophy of the left liver lobe. After 15 years, he developed an episode of cholestasis and jaundice, and was admitted to another center for initial evaluation, involving viral and serological screening for liver causes of jaundice, including the reported intake of ibuprofen. All evaluations were negative, so abdominal contrast-enhanced computed tomography (CT) scan was performed and showed dilation of the common bile duct (CBD) and intrahepatic biliary ducts (IBDs), without evidence of lithiasis and/or pathological interruptions. Liver biopsy was performed and histological evaluation was suspicious for "vanishing bile duct syndrome," so oral steroid therapy was started, but had no clinical benefit.