Systemic absorption of biliary contrast: an unexpected finding – case report

A 21-year-old male with primary sclerosing cholangitis was submitted to a lengthy endoscopic retrograde cholangiopancreatography (ERCP) for evaluation and treatment of a relevant biliary stricture causing obstructive cholestasis. At first (Fig. 1), a cholangiogram was produced using radiopaque contrast. Toward the end of the uneventful procedure (Fig. 2), a contrast pyelogram became progressively more evident. Although systemic absorption of contrast during ERCP is well documented, it is thought to be significantly lower compared to other contrast-dependant exams [1], [2], [3]. However, it is important to consider individual variability, since some patients may have higher systemic absorption, particularly with longer procedures [1].