SESAP Question
==============


**Item 262**

A 21-year-old woman undergoes open cholecystectomy for acute cholecystitis. The cholangiogram shown is obtained. Common bile duct exploration with choledochoscopy fails to remove impacted stones in the ampulla of Vater.

The most appropriate next step would be

1.  placement of a T-tube

2.  immediate endoscopic retrograde cholangiopancreatogram and sphincterotomy

3.  transduodenal sphincteroplasty

4.  choledochojejunostomy

5.  infusion of chenodeoxycholic acid into the common bile duct

For the incomplete statement above, select the *one* completion that is BEST of the 5 given.

For the critique of item 262 see page 397.

![Figure1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/41/5/350/F1.medium.gif)

[Figure1](http://canjsurg.ca/content/41/5/350/F1)

## Footnotes

*   (Reproduced by permission from *SESAP****’****96–****’****98 Syllabus Surgical Education and Self-Assessment Program*, Volume 1, 9th edition. For enrolment in the Surgical Education and Self-Assessment Program, please apply to the American College of Surgeons, 55 East Erie St., Chicago, IL 60611, USA.)