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

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Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation ofintrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochalcyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Variousprocedures have been reported as treatments for postoperative bile duct stone formation. We report a case in whichpercutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed aftercholedochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy whenhe was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performedin 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 hepaticduct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporealshockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were notsmall enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwentpercutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHLis an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision.
長崎大学医学部の論文

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

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概要

長崎大学医学部 | 論文

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