An impacted biliary stone

Maria Triantafyllou, Iosif Beintaris, Dimitrios Polymeros, Konstantinos Triantafyllou

Attikon University General Hospital, Faculty of Medicine, Athens University, Athens, Greece

Hepatogastroenterology Unit, Second Department of Internal
Medicine and Research Institute, Attikon University General
Hospital, Faculty of Medicine, Athens University, Athens, Greece

Conflict of Interest: None

Correspondence to: Dr Konstantinos Triantafyllou, MD, PhD,
Hepatogastroenterology Unit, Second Department of Internal
Medicine and Research Institute, Attikon University General
Hospital, Faculty of Medicine, Athens University, Rimini 1, 12462
Haidari, Athens, Greece, Tel.: +30 210 5832090,
Fax: +30 210 5326422, e-mail: ktriant@med.uoa.gr

Received 15 October 2012; accepted 5 November 2012

The most common cause of biliary obstruction is choledocholithiasis. Endoscopic sphincterotomy is the preferred therapy for retained common bile duct stones. However, stones may pass spontaneously or get impacted at the ampulla [1]. Recent data suggest that precut sphincterotomy is a safe and effective technique that facilitates impacted stone extraction [2].

A 60-year-old man was admitted due to obstructive jaundice (total bilirubin: 15.53 mg/dL and direct bilirubin: 11.90 mg/dL) (<0.2 mg/dl) with MRCP with MRCP showing choledocholithiasis, in order to undergo ERCP. During ERCP a stone impacted in the orifice of Vater’s papilla was detected (Fig. 1A). A precut papillotomy was performed with automatic expulsion of the stone (Fig. 1B). The patient was discharged in good general condition with improvement in the cholestatic and hepatic enzymes.

References

1. Naitoh I, Nakazawa T, Ohara H, et al. A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective. JOP 2008;9:520-525.

2. DaVee T, Garcia JA, Baron TH. Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatogrphy. Ann Gastroenterol 2012 ;25 :291-302.