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Flail Chest-II01:26

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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
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Impacted and Fractured Biliary Basket: A Second Basket Rescue Technique.

Mohammed Amine Benatta1, Ariane Desjeux2, Marc Barthet2

  • 1Digestive Endoscopy Unit, Central Hospital of Army (HCA), 16000 Algiers, Algeria.

Case Reports in Medicine
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Summary

A novel technique successfully removed impacted common bile duct stones during endoscopic retrograde cholangiopancreatography (ERCP) after standard basket extraction failed. This approach avoided surgery in a rare case of fractured retrieval basket.

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Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Biliary Interventions

Background:

  • Management of large and multiple common bile duct stones often requires endoscopic retrograde cholangiopancreatography (ERCP).
  • Basket extraction is a common method for stone removal, but impaction can occur, complicating the procedure.

Purpose of the Study:

  • To describe a novel "rescue" technique for managing a fractured retrieval basket during ERCP for impacted common bile duct stones.
  • To report a case of successful non-surgical removal of impacted stones using this innovative approach.

Main Methods:

  • The patient underwent ERCP for large, multiple common bile duct stones.
  • During a second ERCP, a retrieval basket became impacted with a stone.
  • The basket handle was severed, and a lithotriptor sheath was advanced over the basket.
  • Mechanical lithotripsy failed, and basket wires fractured.
  • A "rescue" standard basket was used to engage and extract the entire fractured basket/stone complex.

Main Results:

  • The "rescue" basket technique successfully disengaged and removed the impacted, fractured basket and stone complex.
  • The procedure avoided the need for surgical intervention.
  • This represents the third reported case of such a complication and its resolution in the English literature.

Conclusions:

  • A "rescue" basket technique can be effective in managing fractured retrieval baskets during ERCP for impacted common bile duct stones.
  • This method offers a non-surgical alternative for a rare but challenging complication.
  • Further investigation into similar techniques may be warranted for difficult stone extraction cases.