Stone Fragmentation Technologies and the Approach to Impacted Stones
Impacted bile duct stones may complicate operative or endoscopic removal. Sometimes, these stones require fragmentation before they can be accessed and/or retrieved. Fragmentation technologies and techniques are described in detail, including potential risks and complications.
KeywordsImpacted stones Lithotripsy Fragmentation Gallstone composition
Images of a large solitary stone within the bile duct with marked mismatch to cystic duct diameter. It appeared to be a secondary bile duct stone which had enlarged over time after passage down the cystic duct. Semirigid curved choledochoscope (Storz, Germany) access facilitated pneumatic fragmentation and trans-cystic stone removal (MOV 192594 kb)
Heavily edited images of trans-cystic exploration of bile duct with initial stone clearance with Nathanson basket (Wilson Cook, America) delivered by the cholangiogram clamp, followed by short semirigid ureteroscopic pneumatic fragmentation of impacted stone (MOV 485478 kb)