If AH is accidentally encountered during surgery, the procedure should differ depending on the inflammatory state of the appendix. Simultaneously operating AH and contralateral recurrent IH is complicated; it is necessary to preoperatively decide which side to operate on first and whether to use an anterior or laparoscopic posterior surgical approach. If the planned operation is unattainable, alternative surgery should be considered. Fortunately, herein CT was performed prior to surgery, and the surgical plan was properly established. Prior to simultaneous AH and contralateral recurrent IH surgery, the surgical plan should be established. If the planned surgical technique for recurrent hernia repair is not feasible, an alternative should be performed. In AH repair, different surgical methods are required depending on the presence and severity of inflammation of the appendix. Endoscopic retrograde cholangiopancreatography (ERCP) is an excellent endoscopic method with a wide range of diagnostic and therapeutic utility. The most common complication is post-ERCP pancreatitis with a reported incidence of 3.5 % followed by cholangitis, cholecystitis, gastrointestinal bleeding and duodenal perforation. Uncommon complications of the procedure reported in the literature include contrast allergy, cardio-pulmonary compromise, problems related to instruments such as impaction of a retrieval basket, fractured guidewire in the biliary or pancreatic channel, extravasation of contrast medium into the duodenal wall, splenic hemorrhage, hepatic trauma and complications related to the electrosurgical risk. Following radiological and laboratory analysis, ERCP was completed. In our first attempt to selectively cannulate the CBD, unintentionally a guide wire passed in the main pancreatic duct. Attempting to retract the guide wire under fluoroscopy surveillance, the guide wire was fractured and fragments were left in the main pancreatic duct. Removal of the fragments was unsuccessful in several attempts. Consecutively, selective cannulation of the main pancreatic duct with placement of the pancreatic stent 5Fr/5cm was performed and careful cannulation of CBD was achieved. After the sphincterotomy, the biliary sludge and microlites were dispatched into the duodenum. The pancreatic stent was removed seven days later and patient underwent cholecystectomy four months later. No complications related to the procedure were revealed during the 24 months of follow-up.

With Regards,
Sara Giselle
Associate Managing Editor
Global Journal of Digestive Diseases