title: Percutaneous transhepatic holmium laser lithotripsy of a large common bile duct stone.
abstract: A 58-year-old woman presented with a 4 cm obstructing choledocolith within the proximal common bile duct. She had an extensive operative history resulting in common bile duct to jejunum anastomosis after cholecystectomy. Endoscopic retrograde cholangiopancreatography (ERCP) removal was unsuccessful, and surgical exploration was contraindicated due to multiple comorbidities. Interventional radiologist placement of bilateral transhepatic ureteral access sheaths allowed Urologist evaluation of the biliary tract by ureteroscope. Holmium laser lithotripsy was performed with successful fragmentation of the stone and clearance of the obstruction, without complication. The case is relevant to the growing literature on the management of refractory biliary stones after failed ERCP.
authors.affiliation: Department of Radiology, Eastern Virginia Medical School, PO Box 1980, 600 Gresham Dr, Norfolk, VA 23501, USA.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Deal
authors.affiliation: Department of Radiology, Eastern Virginia Medical School, PO Box 1980, 600 Gresham Dr, Norfolk, VA 23501, USA.
authors.forename: Shashidhara
authors.initials: S
authors.lastname: Murthy
authors.affiliation: Eastern Virginia Medical School, Urology of Virginia, Virginia Beach, Virginia, USA.
authors.forename: Shaun
authors.initials: S
authors.lastname: Wason
authors.affiliation: Eastern Virginia Medical School, Medical Center Radiologists, Virginia Beach, Virginia, USA.
authors.forename: Harlan
authors.initials: H
authors.lastname: Vingan
authors.affiliation: Eastern Virginia Medical School, Urology of Virginia, Virginia Beach, Virginia, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fabrizio
keywords: Biliary intervention; Choledocolithiasis; Holmium laser; Interventional radiology; Percutaneous lithotripsy