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Misbahuddin-Leis M, Ankolvi M, Mishra M, Dubasz K, Marinov A, Müller T, Graeb C, Radeleff B. Unlocking the enigma: Combined percutaneous-transhepatic and endoscopic strategies for retrieval of severed Dormia basket in choledocholithiasis. A case report and literature review. Radiol Case Rep 2024; 19:2745-2750. [PMID: 38680740 PMCID: PMC11047170 DOI: 10.1016/j.radcr.2024.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Choledocholithiasis, characterized by the presence of stones in the common bile duct, poses significant challenges in clinical management, particularly when the stones are massive. While endoscopic methods are often effective in stone removal, complications such as the impaction of foreign bodies like Dormia baskets can occur. These complications may necessitate alternative approaches, including surgical intervention, highlighting the importance of exploring innovative interventional techniques. We report on an 89-year-old patient presenting with massive choledocholithiasis, involving complete filling of the intra- and extrahepatic bile duct system with large stones up to a maximum of 2 cm. The patient underwent interventional removal of a Dormia basket (3.5Fr. Boston Scientific, USA) impacted in the common bile duct. This procedure proved challenging due to the metallic end marker of the basket perforating through the wall of the distal common bile duct, rendering it fixed. Given the complexity of the case, a parallel approach combining percutaneous transhepatic cholangiography and drainage with simultaneous endoscopy was employed to successfully extract the fixed Dormia basket. In cases of severe choledocholithiasis complicated by the impaction of foreign bodies such as Dormia baskets, innovative interventional strategies are crucial for successful management. Our case highlights the effectiveness of a parallel approach involving percutaneous transhepatic cholangiography and drainage alongside simultaneous endoscopy in safely removing the fixed foreign body from the common bile duct. This multidisciplinary approach not only offers a viable alternative to surgical intervention but also underscores the importance of collaboration between interventional radiologists and endoscopists in optimizing patient outcomes in complex biliary interventions.
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Affiliation(s)
- Mohammed Misbahuddin-Leis
- Medical Faculty Heidelberg, Heidelberg University
- Department of Diagnostic and Interventional Radiology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Muzaffer Ankolvi
- Department of Diagnostic and Interventional Radiology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Manisha Mishra
- Department of Diagnostic and Interventional Radiology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Krisztina Dubasz
- Medical Faculty Heidelberg, Heidelberg University
- Department of Diagnostic and Interventional Radiology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Aleksander Marinov
- Department of Gastroenterology, Hepatology, Infectiology, Hematology and Oncology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Thomas Müller
- Department of Gastroenterology, Hepatology, Infectiology, Hematology and Oncology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Christian Graeb
- Department of Visceral and Abdominal Surgery, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, Sana Klinikum Hof GmbH, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nuremberg
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Doshi B, Yasuda I, Ryozawa S, Lee GH. Current endoscopic strategies for managing large bile duct stones. Dig Endosc 2018; 30 Suppl 1:59-66. [PMID: 29658655 DOI: 10.1111/den.13019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022]
Abstract
Common bile duct stones are a relatively common occurrence and can often lead to devastating complications. Endoscopic retrograde cholangiopancreatography was introduced in the 1970s for management of common bile duct stones. Most common bile duct stones can be removed with simple techniques such as endoscopic sphincterotomy and balloon trawling. However, large bile duct stones continue to pose some difficulty in achieving complete extraction. In this article, we will review some of the established techniques such as the use of endoscopic papillary large balloon dilatation, mechanical lithotripsy, and cholangioscopy-assisted techniques. We will look at the recent literature to help clarify the particular methods and answer some of the questions surrounding these methods.
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Affiliation(s)
- Bhavesh Doshi
- National University Health System, Division of Gastroenterology and Hepatology, University Medicine Cluster, Singapore
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Shomei Ryozawa
- Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Guan Huei Lee
- National University Health System, Division of Gastroenterology and Hepatology, University Medicine Cluster, Singapore
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3
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Laparoscopic Common Bile Duct Exploration for Retrieval of Impacted Dormia Basket following Endoscopic Retrograde Cholangiopancreatography with Mechanical Failure: Case Report with Literature Review. Case Rep Surg 2017; 2017:5878614. [PMID: 28785504 PMCID: PMC5530427 DOI: 10.1155/2017/5878614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
Dormia baskets are commonly used during endoscopic retrograde cholangiopancreatography (ERCP). One complication is basket retention, through impaction with a gallstone or wire fracture. We describe a case where the external handle of the basket snapped causing retained basket plus large gallstone impacted in the common bile duct (CBD). Following laparoscopic cholecystectomy, laparoscopic CBD exploration allowed direct stone fragmentation under vision with the choledochoscope. Fragments were removed using a choledochoscopic basket and Fogarty catheter, and the basket was withdrawn. Literature search identified 114 cases of retained baskets with management including shockwave lithotripsy (27%), papillary balloon dilatation (22%), open CBD exploration (11%), and one laparoscopic case.
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Yilmaz S, Ersen O, Ozkececi T, Turel KS, Kokulu S, Kacar E, Akici M, Cilekar M, Kavak O, Arikan Y. Results of the open surgery after endoscopic basket impaction during ERCP procedure. World J Gastrointest Surg 2015; 7:15-20. [PMID: 25722797 PMCID: PMC4325280 DOI: 10.4240/wjgs.v7.i2.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/06/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography (ERCP) procedure.
METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients. These patients were immediately operated for removal of stone(s) and impacted basket. The postoperative course, length of hospital stay, diameter of the stone, complication and the surgical procedure of the patients were reported retrospectively.
RESULTS: Six patients (M/F, 0/6) were operated due to impacted basket during ERCP procedure. The mean age of the patients was 64.33 ± 14.41 years. In all cases the surgery was performed immediately after the failed ERCP procedure by making a right subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d.
CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.
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Kim CW, Chang JH, Kim TH, Han SW. Rescue balloon dilation of the ampulla for retrieving an impacted biliary extraction basket. J Dig Dis 2014; 15:636-9. [PMID: 25139476 DOI: 10.1111/1751-2980.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Chang Whan Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
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Young Bang J, Coté GA. Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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A novel two-step approach for retrieval of an impacted biliary extraction basket. Case Rep Gastrointest Med 2012; 2012:435050. [PMID: 22953076 PMCID: PMC3431071 DOI: 10.1155/2012/435050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/24/2012] [Indexed: 01/01/2023] Open
Abstract
Biliary extraction baskets are a commonly used instrument for the removal of choledocholithiasis in endoscopic retrograde cholangiopancreatography (ERCP). Impaction of the extraction basket is a recognized complication of ERCP, and is usually the result of discrepancy between the size of bile duct stone and the diameter of the distal bile duct. Whilst mechanical lithotriptors can be used to crush the stone or break the wires of the basket to allow its release, failure of the lithotriptor device can occur. We describe the case of a 59-year-old gentleman who had an ERCP performed for choledocholithiasis. Basket impaction was encountered, and the mechanical lithotriptor failed to dislodge the stone/basket complex. A two-step technique involving balloon dilatation and forceps manipulation of the basket was applied to successfully dislodge the impacted basket. We believe this simple and safe technique should be adopted to rescue impacted biliary extraction baskets to avoid the need for potential surgical removal.
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Choi EK, Lehman GA. Update on endoscopic management of main pancreatic duct stones in chronic calcific pancreatitis. Korean J Intern Med 2012; 27:20-9. [PMID: 22403495 PMCID: PMC3295984 DOI: 10.3904/kjim.2012.27.1.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 12/14/2011] [Indexed: 12/12/2022] Open
Abstract
Pancreatic duct stones are a common complication during the natural course of chronic pancreatitis and often contribute to additional pain and pancreatitis. Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused in part by obstruction of the pancreatic duct system (by stones or strictures) resulting in increasing intraductal pressure and parenchymal ischemia. Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. In this review, updated management of pancreatic duct stones is discussed.
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Affiliation(s)
- Eun Kwang Choi
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen A. Lehman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Kwon JH, Lee JK, Lee JH, Lee YS. Percutaneous transhepatic release of an impacted lithotripter basket and its fractured traction wire using a goose-neck snare: a case report. Korean J Radiol 2011; 12:247-51. [PMID: 21430943 PMCID: PMC3052617 DOI: 10.3348/kjr.2011.12.2.247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/01/2010] [Indexed: 12/21/2022] Open
Abstract
In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.
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Affiliation(s)
- Jae Hyun Kwon
- Division of Interventional Radiology, Department of Radiology, Dongguk University Ilsan Hospital, Dongguk University, Gyeonggi-do 410-773, Korea.
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Ryozawa S, Iwano H, Taba K, Senyo M, Sakaida I. Successful retrieval of an impacted mechanical lithotripsy basket: a case report. Dig Endosc 2010; 22 Suppl 1:S111-3. [PMID: 20590757 DOI: 10.1111/j.1443-1661.2010.00963.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the successful retrieval of an impacted mechanical lithotripsy basket. In a patient with two large common bile duct stones, the basket with the entrapped stone was impacted within the mid-common bile duct. We then attempted to use another mechanical lithotripter; however the central wire of the basket fractured at the handle portion. Grasping a few wires of the impacted basket with rat-tooth forceps allowed the wires of the basket to slip away from the stone. The present report describes the safe and effective use of rat-tooth forceps in the management of an impacted lithotripter basket.
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Affiliation(s)
- Shomei Ryozawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
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Adler DG, Conway JD, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA, Tierney WM. Biliary and pancreatic stone extraction devices. Gastrointest Endosc 2009; 70:603-9. [PMID: 19788977 DOI: 10.1016/j.gie.2009.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/12/2009] [Indexed: 02/08/2023]
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12
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Nonsurgical management of an impacted mechanical lithotriptor with fractured traction wires: endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 22:699-702. [PMID: 18701948 DOI: 10.1155/2008/798527] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a patient with a mid-common bile duct stone, the traction wires of a mechanical lithotriptor snapped, resulting in lithotriptor basket impaction. Simultaneous occurrence of these two potential complications of endoscopic stone extraction is very rarely reported. Extracorporeal shock wave lithotripsy failed to fragment the stone entrapped within the impacted basket. Endoscopic intracorporeal electrohydraulic shock wave lithotripsy successfully fragmented the stone under direct visualization through a cholangioscope. The entrapped stone within the basket could subsequently be pulled into the supra-ampullary bile duct for the final fragmentation with an extra-endoscopic mechanical lithotriptor cable. The present report is the first to describe a safe and effective use of endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy in the management of an impacted lithotriptor basket.
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