Balloon Sphincteroplasty and Transpapillary Elimination of Bile Duct Stones: 10 Years' Experience

HOME

HELP

FEEDBACK

SUBSCRIPTIONS

Balloon Sphincteroplasty and Transpapillary Elimination of Bile Duct Stones: 10 Years' Experience

José H. García-Vila¹, Marta Redondo-Ibáñez and Carlos Díaz-Ramón

¹ All authors: Department of Radiology, Hospital General de Castelló, Avda. Benicasim, s/n. Castelló 12004, Spain.

View larger version (180K):

[in a new window]

Fig. 1A. —83-year-old man who presented with sepsis and obstructive jaundice 12 years after undergoing cholecystectomy. Cholangiogram of percutaneous biliary drainage shows, along with lack of dilatation of intrahepatic ducts, multiple stones in left hepatic and common bile duct.

View larger version (145K):

[in a new window]

Fig. 1B. —83-year-old man who presented with sepsis and obstructive jaundice 12 years after undergoing cholecystectomy. Cholangiogram obtained 12 days after A shows that sepsis has remitted. Sphincteroplasty was performed with balloon diameter of 16 mm.

View larger version (146K):

[in a new window]

Fig. 1C. —83-year-old man who presented with sepsis and obstructive jaundice 12 years after undergoing cholecystectomy. Cholangiogram shows occlusion balloon pushing stones to duodenum.

View larger version (150K):

[in a new window]

Fig. 1D. —83-year-old man who presented with sepsis and obstructive jaundice 12 years after undergoing cholecystectomy. Final cholangiogram, obtained 4 days after C, shows removal of calculi and flow of contrast material into duodenum through contractile sphincter.

View larger version (142K):

[in a new window]

Fig. 2A. —71-year-old woman at high surgical risk, who underwent cholecystectomy 15 years before and presented with choledocholithiasis. She underwent failed endoscopic approach. Cholangiogram of right percutaneous biliary drainage shows single stone (22 mm in diameter) and mild dilation of intrahepatic bile ducts.

View larger version (127K):

[in a new window]

Fig. 2B. —71-year-old woman at high surgical risk, who underwent cholecystectomy 15 years before and presented with choledocholithiasis. She underwent failed endoscopic approach. Cholangiogram shows sphincteroplasty with 23-mm balloon. In next step, stone could be successfully pushed to duodenum.

View larger version (171K):

[in a new window]

Fig. 2C. —71-year-old woman at high surgical risk, who underwent cholecystectomy 15 years before and presented with choledocholithiasis. She underwent failed endoscopic approach. Cholangiogram obtained 3 days after B shows absence of stones and wide contractile sphincter. Clinical situation of patient was satisfactory.

View larger version (133K):

[in a new window]

Fig. 3A. —67-year-old woman who underwent laparoscopic cholecystectomy and stone extraction by choledochotomy. Cholangiogram obtained 7 days after surgery shows four residual stones and Kehr tube with redundant trajectory about to come out of bile duct. For this reason, we decided to eliminate stones without waiting for further maturation of tract.

View larger version (171K):

[in a new window]

Fig. 3B. —67-year-old woman who underwent laparoscopic cholecystectomy and stone extraction by choledochotomy. Cholangiogram shows multipurpose catheter and guide before correcting curve described by Kehr tube.

View larger version (141K):

[in a new window]

Fig. 3C. —67-year-old woman who underwent laparoscopic cholecystectomy and stone extraction by choledochotomy. Cholangiogram shows that after curve is rectified, introducer is put into position and balloon sphincteroplasty (10 mm in diameter) is performed.

View larger version (156K):

[in a new window]

Fig. 3D. —67-year-old woman who underwent laparoscopic cholecystectomy and stone extraction by choledochotomy. Cholangiogram obtained 4 days after A–C shows complete clearance of calculi.

View larger version (108K):

[in a new window]

Fig. 4A. —92-year-old woman with acute lithiasic cholecystitis. Because she was high risk for surgery, percutaneous cholecystostomy was performed. Cholangiogram obtained 4 days after percutaneous cholecystostomy shows that multiple large gallstones and multiple choledocholithiasis could be seen.

View larger version (168K):

[in a new window]

Fig. 4B. —92-year-old woman with acute lithiasic cholecystitis. Because she was high risk for surgery, percutaneous cholecystostomy was performed. Cholangiogram obtained 11 days after A shows sphincteroplasty (14-mm balloon) and elimination of stones into duodenum through cholecystostomy.

View larger version (105K):

[in a new window]

Fig. 4C. —92-year-old woman with acute lithiasic cholecystitis. Because she was high risk for surgery, percutaneous cholecystostomy was performed. Cholangiogram obtained 4 days after B shows that mechanical lithotripsy of gallstones was performed, and they were extracted with Dormia baskets and aspiration.

View larger version (154K):

[in a new window]

Fig. 4D. —92-year-old woman with acute lithiasic cholecystitis. Because she was high risk for surgery, percutaneous cholecystostomy was performed. Cholangiogram obtained 7 days after C shows clearance of stones both in bile duct and in gallbladder. Patient's condition was good, and drainage catheter was removed.

View larger version (136K):

[in a new window]

Fig. 5. —59-year-old woman referred to our unit 30 days after laparoscopic cholecystectomy and removal of stones from common bile duct. Cholangiogram obtained through Ring catheter (William Cook Europe) shows residual calculus and intraabdominal catheter trajectory of 360° curve. This is one of our failures, for we could not rectify trajectory of catheter because it had become stabilized as a result of amount of time that had passed.

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?