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A 87-year-old man presented with obstructive jaundice was admitted to the endoscopy unit. The patient has a history of ERCP 15 years ago due to calcular obstructive jaundice, removing the stones, and inserting a stent. The patient lab showed 8 mg/ dl bilirubin, which is direct, moderately elevated transaminases, lymphopenia (may be COVID- 19), and a platelet count of 55000. The ultrasonography and non-contrast CT showed a stone 1.2 cm at the duodenal end of CBD and liver cirrhosis. The patient underwent ERCP. The scope revealed a stone at the tip of the duodenal ampulla. Cannulation of the CBD led to the lodge of the stone into the interior of the CBD. Cholangiogram showed a filling defect inside the CBD. Once the stone passed inside the CBD, much pus was discharged, denoting cholangitis. An atrial extraction of the stone with a basket was failed. Dilatation of the ampulla using a sphincterotomy, then a balloon was successfully used to extract the stone.
