PMC5907686_01
A: Presence of multiple CBD stones with previous stent in-situ. B: Dilated CBD with multiple stones. C: Failure of deployment of mechanical lithotripter demonstrated, due to space constraints within CBD.
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Initial cholangiogram confirmed the presence of multiple large CBD stones (Fig. 1A). Another cholangiogram after stent removal revealed more clearly the presence of upstream biliary dilation (Fig. 1B). A BML-V442QR-30 single-use mechanical lithotripter (Olympus, Shinjuku, Tokyo, Japan) was inserted into the CBD but could not be fully deployed due to the extremely limited space within the CBD from the multiple large stones (Fig. 1C).
A and B Sequential images demonstrating waisting of balloon dilator within CBD due to multiple stones. C: Resolution of balloon dilator waisting, indicating adequate space created from balloon dilation.
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There was initial waisting of the balloon (Fig. 2A and B), which consequently improved significantly on sustained insufflation at the highest allowed pressure (Fig. 2C).
A: Re-introduction of mechanical lithotripter with successful deployment, trapping and lithotripsy of CBD stones. B: Trawling of CBD stones with routine balloon catheter.
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Subsequently, the same mechanical lithotripter was re-introduced into the CBD with successful full deployment and trapping of the CBD stones (Fig. 3A). An additional 20 min was spent crushing the stones rather uneventfully and the debris was trawled out in a routine fashion using a balloon catheter (Fig. 3B).
Insertion of plastic stent post-clearance of CBD stones for unobstructed biliary drainage.
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A 10 Fr, 12 cm plastic stent was inserted for continued unobstructed biliary drainage (Fig. 4).