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Fish bone as a nidus for stone formation in the common bile duct: report of two cases.

Kim YH, Kim YJ, Park WK, Lee SK, Kwon JH, Woo SK - Korean J Radiol (2004 Jul-Sep)

Bottom Line: We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings.After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance.A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Jung-gu, Taegu, Korea. yhkim68@dsmc.or.kr

ABSTRACT
We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

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A 75-year-old woman with common bile duct stone.
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Figure 1: A 75-year-old woman with common bile duct stone.

Mentions: A 75-year-old woman who had no history of previous abdominal surgery was admitted to the emergency room for the treatment of cholangitis. Ultrasonography (US) showed the presence of a common bile duct (CBD) stone with mild dilatation of the bile duct (Fig. 1A). Computed tomography (CT) also revealed the presence of a CBD stone, containing a characteristic bright dot corresponding to the density of bone (Fig. 1B). Percutaneous transhepatic biliary drainage (PTBD) was performed to control for biliary sepsis. The percutaneous transhepatic cholangiogram (PTC) showed an elongated filling defect in the CBD (Fig. 1C). After 5 days, sepsis was successfully controlled and the infected bile containing pus changed to a clear yellow color. After obtaining informed consent from the patient, we extracted the stone through a previously created PTBD tract under fluoroscopic guidance. After the patient was prepared and draped on the fluoroscopic table, pethidine 50 mg was given intramuscularly prior to the procedure. 0.035-inch Radifocus guidewire M, of the angled stiff type (Terumo, Tokyo, Japan) was inserted and the PTBD catheter was replaced by a 12-F sheath catheter (Cook, Bloomington, IN). A cholangiogram was obtained to evaluate the contour of the bile ducts and the location of the stones within the CBD. After obtaining the cholangiogram, a Wittich nitinol stone basket (Cook Bloomington, IN) was inserted through the sheath catheter beyond the stone. The stone was trapped by rotating the basket and was then extracted through the sheath catheter. There was no evidence of residual stone or choledochoenteric fistula on the completion cholangiogram. The postoperative course was uneventful. The stone was friable, brittle, elongated and pigmented, containing a nidus of fish bone 1.5 cm in length (Fig. 1D).


Fish bone as a nidus for stone formation in the common bile duct: report of two cases.

Kim YH, Kim YJ, Park WK, Lee SK, Kwon JH, Woo SK - Korean J Radiol (2004 Jul-Sep)

A 75-year-old woman with common bile duct stone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698163&req=5

Figure 1: A 75-year-old woman with common bile duct stone.
Mentions: A 75-year-old woman who had no history of previous abdominal surgery was admitted to the emergency room for the treatment of cholangitis. Ultrasonography (US) showed the presence of a common bile duct (CBD) stone with mild dilatation of the bile duct (Fig. 1A). Computed tomography (CT) also revealed the presence of a CBD stone, containing a characteristic bright dot corresponding to the density of bone (Fig. 1B). Percutaneous transhepatic biliary drainage (PTBD) was performed to control for biliary sepsis. The percutaneous transhepatic cholangiogram (PTC) showed an elongated filling defect in the CBD (Fig. 1C). After 5 days, sepsis was successfully controlled and the infected bile containing pus changed to a clear yellow color. After obtaining informed consent from the patient, we extracted the stone through a previously created PTBD tract under fluoroscopic guidance. After the patient was prepared and draped on the fluoroscopic table, pethidine 50 mg was given intramuscularly prior to the procedure. 0.035-inch Radifocus guidewire M, of the angled stiff type (Terumo, Tokyo, Japan) was inserted and the PTBD catheter was replaced by a 12-F sheath catheter (Cook, Bloomington, IN). A cholangiogram was obtained to evaluate the contour of the bile ducts and the location of the stones within the CBD. After obtaining the cholangiogram, a Wittich nitinol stone basket (Cook Bloomington, IN) was inserted through the sheath catheter beyond the stone. The stone was trapped by rotating the basket and was then extracted through the sheath catheter. There was no evidence of residual stone or choledochoenteric fistula on the completion cholangiogram. The postoperative course was uneventful. The stone was friable, brittle, elongated and pigmented, containing a nidus of fish bone 1.5 cm in length (Fig. 1D).

Bottom Line: We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings.After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance.A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Jung-gu, Taegu, Korea. yhkim68@dsmc.or.kr

ABSTRACT
We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

Show MeSH
Related in: MedlinePlus