[Extracorporeal shock waves lithotripsy during acute obstruction of the cystic duct]

Obstruction of the cystic duct after Biliary Shock Waves Lithotripsy in an uncommon complication. It occurs when a small fragment is hemming in the neck of the gallbladder. Usually, cholecystectomy is the indicated treatment, we challenged this concept and attempted early ESWL to treat this complication. In our clinic, 150 patients were treated with a Lithostar-Plus device between March 1, 1989 to April 30, 1990. Of these, 12 presented acute uncontrolled biliary colic, 28 presented mild abdominal pain and the rest, remained pain free. Of the 12, one presented biliary obstruction and cholecystectomy was performed in other hospital; one refused to be retreated and other presented sonographic gallbladder thickness and hence underwent surgery. Nine patients were re-treated and in all, fragments nested in the gallbladder neck were successfully pulverised and obstruction cleared. To date all patients are free of stones. In summary, we propose early re-treatment with ESWL as a non-surgical alternative approach for treating this complication.