Brief ReportBiliary-basket impaction complicated by in vivo traction-wire fracture: report of a novel management approach
Section snippets
Case report
A 76-year-old man with choledocholithiasis was referred for ERC. The CBD was easily accessed, and cholangiography demonstrated 3 filling defects in a 7-mm CBD (Fig. 1). After maximal biliary sphincterotomy, initial attempts to clear the stones with a balloon catheter failed. Thus, a 7F Web Extraction Basket (Cook Endoscopy) was passed into the distal CBD and at least 1 stone was captured. Unfortunately, the stone(s) would not fragment, and the basket could not be withdrawn into the duodenum (
Discussion
Very few cases describe the convergence of 2 potential complications of endoscopic stone extraction: a lithotripsy basket impacted in the CBD and its traction wires severed in vivo. Reported management strategies have included the following: use of extracorporeal shock wave lithotripsy ± laser lithotripsy to fragment the stone to facilitate basket retrieval with a forceps or a snare3, 4; use of a second endoscopic mechanical lithotripsy basket to capture the first basket and to crush the stone5
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