Clin Endosc.  2016 Jul;49(4):395-398. 10.5946/ce.2015.109.

Successful Removal of a Large Common Bile Duct Stone by Using Direct Peroral Cholangioscopy and Laser Lithotripsy in a Patient with Severe Kyphosis

• Lee SI
• Lim BH
• Heo WG
• Kim YJ
• Kim TH

• KMID: 2348262
• DOI: http://doi.org/10.5946/ce.2015.109

Abstract

A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.

Keyword

Gallstones; Kyphosis; Cholangiography; Cholangitis

MeSH Terms

Aged
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Common Bile Duct*
Endoscopes
Female
Gallstones
Humans
Hypertension
Kyphosis*
Lasers, Solid-State
Lithotripsy
Lithotripsy, Laser*
Radiography
Thorax

Figure

• 

  Fig. 1. A chest radiograph showing severe kyphosis.

• 

  Fig. 2. A cholangiogram showing a large filling defect that suggests a large stone in the common bile duct.

• 

  Fig. 3. A radiograph demonstrating peroral direct cholangioscopy. (A) Radiographic view showing the ultraslim endoscope in the common bile duct. (B) Endoscopic view showing stone fragmentation using holmium laser lithotripsy.

• 

  Fig. 4. A balloon cholangiogram showing no stones in the common bile duct.

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