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Canadian Journal of Gastroenterology
Volume 22, Issue 8, Pages 699-702
http://dx.doi.org/10.1155/2008/798527
Brief Communication

Nonsurgical Management of an Impacted Mechanical Lithotriptor with Fractured Traction Wires: Endoscopic Intracorporeal Electrohydraulic Shock Wave Lithotripsy Followed by Extra-Endoscopic Mechanical Lithotripsy

Tan Attila, Gary R May, and Paul Kortan

University of Toronto, St Michael’s Hospital, Advanced Therapeutic Endoscopy and Gastrointestinal Oncology Group, Toronto, Ontario, Canada

Received 18 March 2008; Accepted 31 March 2008

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In a patient with a mid-common bile duct stone, the traction wires of a mechanical lithotriptor snapped, resulting in lithotriptor basket impaction. Simultaneous occurrence of these two potential complications of endoscopic stone extraction is very rarely reported. Extracorporeal shock wave lithotripsy failed to fragment the stone entrapped within the impacted basket. Endoscopic intracorporeal electrohydraulic shock wave lithotripsy successfully fragmented the stone under direct visualization through a cholangioscope. The entrapped stone within the basket could subsequently be pulled into the supra-ampullary bile duct for the final fragmentation with an extra-endoscopic mechanical lithotriptor cable. The present report is the first to describe a safe and effective use of endoscopic intracorporeal electrohydraulic shock wave lithotripsy followed by extra-endoscopic mechanical lithotripsy in the management of an impacted lithotriptor basket.