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Percutaneous stone removal using cobra-shaped sheath and cholangioscopy for multiple hepatolithiasis with

Fumio Chikamori1, Shigeto Shimizu1, Satoshi Ito2

  • 1Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan.

Radiology Case Reports
|April 11, 2022
PubMed

Insights

This study presents a minimally invasive technique for managing complex hepatolithiasis (bile duct stones) with anastomotic stenosis. The novel approach utilized percutaneous transhepatic balloon dilatation and a cobra-shaped sheath for effective stone removal, improving patient outcomes.

Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Hepatobiliary Surgery

Background:

  • Management of multiple hepatolithiasis, especially with concomitant choledochoenteral anastomotic stenosis, poses significant clinical challenges.
  • Existing treatment modalities are often invasive and time-consuming, necessitating innovative approaches.

Observation:

  • A case report details the treatment of a 77-year-old male presenting with severe right hypochondralgia.
  • The patient underwent percutaneous transhepatic balloon dilatation for choledochoduodenal anastomotic stenosis.

Findings:

  • Percutaneous stone removal was performed using an 8Fr. cobra-shaped sheath and cholangioscopy.
  • Hilar hepatic stones were successfully navigated into the duodenum via the dilated anastomosis.
  • Intrahepatic bile duct stones were removed using the cobra-shaped sheath, guidewire, and a removal balloon catheter.
  • Balloon-occluded cholangiography confirmed complete clearance of intrahepatic bile duct stones.

Implications:

  • The use of a cobra-shaped sheath demonstrates potential for improved percutaneous stone removal in complex hepatolithiasis cases.
  • While effective, the described procedure indicates a need for further refinement to optimize efficacy and reduce procedural complexity.

Keywords:
Choledochoduodenostomy, choledochoenterostomyCobra-shaped sheathHepatolithiasisPercutaneous balloon dilatationPercutaneous stone removal

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