Combined Percutaneous Balloon Dilation and Extracorporeal Shock Wave Lithotripsy for Treatment of Biliary Stricture and Common Bile Duct Stones

We report a case of cholangitis, liver ahscess, and common bile duct stones in a patient with a benign stricture at a choledochojejunal anastomosis, 3 yr after a complicated duodenohemipancreatectomy. Because surgical reintervention seemed inappropriate, a percutaneous transhepatic balloon dilation was performed after temporary internal-external biliary drainage. Extra-corporeal Shockwave lithotripsy (ESWL) was successfully applied to fragment all common bile duct stones, with suhsequent spontaneous evacuation of all stone fragments through the dilated bilioenteric anastomosis. Only one similar case report has been published before (1), though with a different sequence of therapeutic modalities. Moreover, according to our literature review, this is the first report of ESWL of common bile duct stones by means of the Dornier Compact Lithotriptor (Dornier, Germany) with electromagnetic Shockwave source.