Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

Abstract

The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-year-old woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm x 15 mm). We diagnosed her with choledocholithiasis and performed endoscopic retrograde cholangiopancreatography to remove the stone. However, unfortunately, the retrievable basket around the stone became impacted. An endotriptor along with forceps could not be used owing to the entrapment of the basket, and thus we performed urgent surgery. The basket containing the stone was removed through a longitudinal choledochotomy. The wires leading to the basket were cut, and the basket containing the stone was removed via the incision. A T-tube was inserted, and the choledochotomy was closed. The postoperative course was uneventful. In conclusion, if the diameter of a CBD stone is more than 20 mm, then the risk of basket impaction increases, and surgery may be necessary as the initial treatment of the CBD stone.

Surgical removal of a severed Dormia basket from the bile duct

“…Stones that are 2 cm in diameter or larger are prone to becoming embedded in the wire loops during removal [1]. In addition, cholecystitis and/or cholangitis may induce inflammatory changes in the CBD, leading to stiffness and deformation of the duct, which reduces the working space between the stone and the wall of the CBD [2]. Once distortion of the Dormia basket, similar to the that described herein (see • " Fig.…”

“…1), has occurred, impaction or rupture becomes very likely, and it may be better to consider alternative ways of widening of the papilla or fragmenting the stone. In some cases, use of a second basket or shockwave lithotripsy can help remove or fragment the entrapped stone [3,4], but once the basket be- Cases and Techniques Library (CTL) E20 comes severed, with its opened loops facing downwards, manipulation from below is likely impossible and dangerous, and its removal through open choledochotomy may become mandatory [2].…”

Dormia basket impacted during ERCP, resolved by laparoscopic bile duct approach: Case report

“…The main factor responsible for the impaction of the basket and as described in the cases we report, is the large size of the stones (>15–20 mm). Some authors have reported that the presence of a stone larger than 20 mm in size as a contraindication to performing ERCP [ 6 , 19 , 20 ].…”

Rationale for effectiveness of a new method of radial sphincterotomy during obstruction of extrahepatic bile ducts

“…Один из актуальных вопросов -извлечение из холедоха крупных камней (>20 мм). В литературе описаны методы их дробления внутри холедоха посредством интракорпоральной электрогидравлической литотрипсии и дробления корзиной [2,7]. B. Vladimirov приводит данные об успешности литотрипсии у 171 из 236 больных с осложнениями в 11% случаев.…”