Varshney Vaibhav Kumar, Sreesanth K S, Gupta Manish, Garg Pawan Kumar
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Gastroenterology, Goyal Hospital, Jodhpur, Rajasthan, India.
J Minim Access Surg. 2020 Oct-Dec;16(4):415-417. doi: 10.4103/jmas.JMAS_245_19.
We encountered a 73-year-old patient who presented with right upper abdominal pain and jaundice. On evaluation, he was found to have cholelithiasis with choledocholithiasis. Endoscopic retrograde cholangiography was attempted, but during the procedure, the wire snapped and the dormia basket got retained in the common bile duct (CBD). Laparoscopic CBD exploration was performed and the basket with calculus was found impacted in the lower CBD. The basket was disengaged by holding its tip through another dormia introduced through choledochoscope and basket with all calculi retrieved. Clearance of CBD was ascertained with choledochoscopy and CBD was closed primarily. He did well in the post-operative period and was discharged on the 5 post-operative day. At 1-year follow-up, the patient was doing well. Laparoscopic CBD exploration is a feasible and safe option for the retained dormia basket. We utilised the 'dormia with dormia technique' to retrieve the impacted basket which has not been reported before.
我们遇到一名73岁的患者,他出现右上腹疼痛和黄疸。经评估,发现他患有胆囊结石伴胆总管结石。尝试进行内镜逆行胆管造影,但在操作过程中,导丝折断,取石篮滞留在胆总管(CBD)中。进行了腹腔镜胆总管探查,发现带结石的取石篮嵌顿在胆总管下段。通过经胆总管镜插入另一个取石篮抓住原取石篮尖端,使其脱离,取出了所有结石。经胆总管镜确认胆总管通畅后,对胆总管进行了一期缝合。他术后恢复良好,术后第5天出院。在1年的随访中,患者情况良好。腹腔镜胆总管探查对于滞留的取石篮是一种可行且安全的选择。我们采用了“取石篮套取取石篮技术”来取出嵌顿的取石篮,此前尚未有过相关报道。