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Percutaneous transhepatic electrohydraulic lithotripsy for intrahepatic bile duct stones after choledochal cyst excision


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Title: Percutaneous transhepatic electrohydraulic lithotripsy for intrahepatic bile duct stones after choledochal cyst excision
Authors: Obatake, Masayuki / Inamura, Yukio / Taura, Yasuaki / Mochizuki, Kyoko / Nagayasu, Takeshi
Issue Date: Jan-2012
Publisher: Nagasaki University School of Medicine / 長崎大学医学部
Citation: Acta Medica Nagasakiensia, 56(3), pp.99-102; 2012
Abstract: Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation of intrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochal cyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Various procedures have been reported as treatments for postoperative bile duct stone formation. We report a case in which percutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed after choledochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy when he was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performed in our emergency department revealed intrahepatic bile duct stones in minimally dilated intrahepatic bile ducts in both lobes. Percutaneous transhepatic cholangiography showed packed stones distal to the right hepatic duct and stenosis of the right hepatic duct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporeal shockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were not small enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwent percutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHL is an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision.
Keywords: Choledochal cyst / percutaneous transhepatic electrohydraulic lithotripsy / intrahepatic bile duct stones / extracorporeal shockwave lithotripsy
URI: http://hdl.handle.net/10069/27496
ISSN: 00016055
Type: Departmental Bulletin Paper
Text Version: publisher
Appears in Collections:Volume 56, No. 3

Citable URI : http://hdl.handle.net/10069/27496

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