Conventional treatment of lithiasis of the main biliary tract (MBT) is based on endoscopic sphincterotomy followed by extraction of the stone(s) using a balloon catheter and/or Dormia catheter. Several risk factors associated with failure to remove a stone in the main biliary tract have been reported. The most important factor is probably a stone volume greater than 15 mm or an initial diameter of the MBT smaller than that of the stone. Care must be taken not to impact the stone in the Oddi sphincter or in the Dormia in order not to compromise stone removal. Complications associated with the use of the Dormia catheter include bile duct injuries, which are a well-known surgical problem. Injuries specifically related to the use of catheter have been less reported and seem to be underestimated. We here display an image showing Dormia catheter trapped in the bile duct around a fixed stone which couldn´t be removed after endoscopic exploration in a 60-year-old patient with cholangitis caused by lithiasis. Choledochotomy for removal of stone was performed.
Unlike anatomical variant, which is a functional adaptive deviation, congenital anomaly can cause pathological symptoms or, at least, it can pose clinical or paraclinical challenges. Ectopic gallbladder can be isolated or associated with abnormal liver development including lobe with hypertrophy, supernumerary lobe, or agenesis of hepatic lobe. Gallbladder usually lies in the right hypochondrium, below the lower quadrant of the right hepatic lobe. However, it can lie in other sites such as the right flank, the epigastrium, the periumbilical region, the right iliac fossa and even the left hypochondrium in patients with abdominal situs inversus. Its association with white-line hernia has never been reported; this poses clinical challenges and lead to difficulties in surgical approach. We here report a rare case of ectopic epigastric gallbladder lithiasis associated with white-line hernia in a 65-year-old patient admitted in the Emergency Room with diffuse abdominal pain. Abdominal examination showed epigastric swelling with inflammatory signs (
Figure A
). Radiological assessment revealed ectopic gallbladder lithiasis (
Figure B, C
). The patient underwent midline laparoscopic cholecystectomy. The anatomopathological examination of the surgical specimen confirmed the diagnosis.
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