Electroincision and extraction of a gallstone from the duodenal wall for the prevention of gallstone ileus

摘要

An 80-year-old woman with an extensive medical historyincluding appendiceal carcinoid, previous ileocolonicresection, and prior choledocholithiasis was referred formanagement of persistent choledocholithiasis and chronicdiarrhea. The patient initially presented with symptomaticcholedocholithiasis 2 years earlier. ERCP was performed,with plastic biliary stent placement. The patient was lostto follow-up, returning 1 year later with presumed biliarysepsis. Repeated ERCP was performed with stent removal;however, stone clearance was incomplete given a lack ofexpertise and equipment at the outside facility. The patienttherefore underwent placement of percutaneous transhepatic biliary drainage (PTBD). During ERCP, concern forpossible cholecystoenteric fistula was raised. After referralto our institution, the PTBD was removed, and ERCP wasperformed for ductal clearance.