Percutaneous laser lithotripsy for gallbladder and common bile duct stones.
Mirizzi syndrome is a serious disease that, even today, causes significant morbidity and mortality, and is generally considered a contraindication to laparoscopic surgery. Here, we describe a severe cholecystitis patient who was treated successfully with percutaneous transhepatic gallbladder scopic lithotripsy by laser. The patient initially underwent percutaneous transhepatic gallbladder drainage. Subsequent examination revealed a gallbladder stone impacted in the cystic duct. As the patient had a short and thick cystic ductal lumen, we decided to try to crush the stones through the fistula of the gallbladder drainage tube. We first dilated the fistula until it was approximately 12 Fr in size and then performed the percutaneous transhepatic gallbladder scopic lithotripsy procedure. Laser lithotripsy was performed twice to ensure clearance of all stones, including those in the common bile duct. The result was successful nonoperative treatment of a patient with Mirizzi syndrome involving a common bile duct stone, using laser lithotripsy via a cholangiofiber scope. This case suggests that laser lithotripsy is a feasible optional treatment method for severe cholecystitis patients having a percutaneous drainage tube.
Takayama
Satoru
S
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan. takasato@med.nagoya-cu.ac.jp
D001658:Biliary Fistula / Q000209:etiology / Q000628:therapy*; D002764:Cholecystitis / Q000150:complications / Q000628:therapy*; D042883:Choledocholithiasis / Q000150:complications / Q000628:therapy*; D002769:Cholelithiasis / Q000150:complications / Q000628:therapy*; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged