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

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  • OBATAKE Masayuki
    Division of Pediatric Surgery, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences
  • INAMURA Yukio
    Division of Pediatric Surgery, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences
  • TAURA Yasuaki
    Division of Pediatric Surgery, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences
  • MOCHIZUKI Kyoko
    Division of Pediatric Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • NAGAYASU Takeshi
    Division of Pediatric Surgery, Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences

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Excision and hepaticojejunostomy are well-established treatments for choledochal cysts. However, the formation of intrahepatic bile duct stones has been reported as one of the most serious long-term complications on follow-up of choledochal cyst excision. The reported incidence of this complication varies from a small percentage of patients to 10% or more. Various procedures have been reported as treatments for postoperative bile duct stone formation. We report a case in which percutaneous transhepatic electrohydraulic lithotripsy (EHL) was used in the treatment of bile duct stones that developed after choledochal cyst excision. A 17-year-old boy, who had undergone choledochal cyst excision and hepaticojejunostomy when he was 27 days old, presented with colic abdominal pain in the right hypochondriac region and liver dysfunction. CT performed in 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 hepatic duct; there was no evidence of stenosis at the hepaticojejunostomy anastomosis. He underwent extracorporeal shockwave lithotripsy under general anesthesia. Although the large stone was fragmented into smaller stones, they were not small enough to be eliminated due to stenosis of the hepatic duct. After balloon dilatation of the stenosis, the patient underwent percutaneous transhepatic EHL. The fragmented stones were then thoroughly washed out from the intrahepatic bile duct. EHL is an effective and less invasive treatment for intrahepatic bile duct stones after choledochal cyst excision.

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