PMC5530427_01
Gallstone seen near top of common bile duct.
CRIS2017-5878614.001.jpg
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fig1
Dormia basket was left in situ. During repeat ERCP three weeks later the large CBD stone (Figure 1) was engaged in a Dormia basket for mechanical lithotripsy but on cranking the lithotripter handle the wires snapped externally at the mouth (Figure 2).
Dormia basket in CBD, after handle has broken (endoscope has been removed pending urgent surgery).
CRIS2017-5878614.002.jpg
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fig2
Dormia basket was left in situ. During repeat ERCP three weeks later the large CBD stone (Figure 1) was engaged in a Dormia basket for mechanical lithotripsy but on cranking the lithotripter handle the wires snapped externally at the mouth (Figure 2).
Choledochoscopic view of distal CBD. Large stone is seen within impacted ERCP Dormia basket.
CRIS2017-5878614.003.jpg
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fig3
A 5 mm choledochoscope was introduced via a longitudinal choledochotomy and confirmed the presence of an impacted basket plus large stone at the ampulla (Figure 3).
Debulked ERCP Dormia basket now collapsed and ready for removal, with few remaining stone fragments.
CRIS2017-5878614.004.jpg
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fig4
Having debulked the stone load (Figure 4), it was then possible to gently deliver the ERCP Dormia basket back into the duodenum without complication, which could then be removed orally.