title: Lessons learnt from a case of extracorporeal shockwave lithotripsy for a residual gallbladder stone.
abstract: BACKGROUND
  Extracorporeal shockwave lithotripsy (ECSWL) for gallstones is rarely used due to high recurrence rates, but has been reported to be effective in some circumstances.
  
  
  METHODS
  We describe a case of a failed attempt at laparoscopic cholecystectomy due to gallbladder contraction and complete obliteration of Calot's triangle. Cholecystotomy was performed to remove all visible stones, and completed by a subtotal cholecystectomy and closure of the gallbladder remnant. The patient remained symptomatic due to a residual stone in the Hartmann's pouch. ECSWL was attempted to fragment the stone; however, follow-up imaging showed persistence of the calculus.
  
  
  CONCLUSIONS
  Literature review shows that ECSWL for multiple gallbladder stones has a low success rate. Even if a stone is successfully fragmented, a diseased gallbladder remnant seems incapable of expelling the fragments. Without completion endoscopic clearance, therefore, the treatment is considered incomplete.
  
  
  CONCLUSIONS
  Our case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy.
authors.affiliation: General Surgery, Royal Gwent Hospital, Newport, UK. Electronic address: sadikct2@gmail.com.
authors.forename: Sadik
authors.initials: S
authors.lastname: Quoraishi
authors.affiliation: General Surgery, Royal Gwent Hospital, Newport, UK.
authors.forename: Jake
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Department of Urology, Royal Gwent Hospital, Newport, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ponsford
authors.affiliation: General Surgery, Royal Gwent Hospital, Newport, UK.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Rasheed
keywords: Case report; Cholecystectomy; Gallbladder; Gallstones; Lithotripsy