Common bile duct obstruction secondary to a balloon separated from a Fogarty vascular embolectomy catheter during laparoscopic cholecystectomy.
Laparoscopic instrumentation of the common bile duct (CBD) via the transcystic route or through direct choledochotomy seems to be safe, but in rare cases, complications such as pancreatitis, bile duct damage, and hemorrhage from cystic artery may occur. We report an unusual complication with this approach. A 62-year-old man with gallbladder stones presented with obstructive jaundice, mild pancreatitis, and a dilated CBD. He underwent laparoscopic cholecystectomy with an intraoperative cholangiogram through the cystic duct. A small stone seen in the CBD was removed using a 6-Fr vascular Fogarty catheter. Two days later, he became jaundiced again with a rising bilirubin. An endoscopic retrograde cholangiogram showed a 1.5-cm round filling defect floating in a dilated CBD. A sphincterotomy was performed, and a balloon catheter was inflated proximally and pulled down. To our surprise, the filling defect was a crystal clear object, which we finally realized was a fully inflated Fogarty catheter balloon. The balloon spontaneously deflated while being caught with a basket. Surgeons should be aware of this possible complication, and every effort should be made to verify that the balloon still is in place after removal of the embolectomy catheter. Whether vascular embolectomy catheter balloons are appropriate for stone removal or more rigid balloons should be used needs further evaluation.
Mourad
F H
FH
Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box 113-6044 Beirut, Lebanon. fmourad@aub.edu.lb
Khalifeh
M
M
Khoury
G
G
Al-Kutoubi
A
A
D002404:Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery; D002779:Cholestasis / Q000209:etiology* / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000209:etiology* / Q000601:surgery; D004868:Equipment Failure; D006801:Humans; D008297:Male; D008875:Middle Aged