Abstract
Obstinate choledocholithiasis occurs when an obstructing common duct stone is large in size and does not easily respond to simple endoscopic or laparoscopic removal techniques. Such stones increase the risk of complications from causing biliary obstruction and from requiring more invasive methods of extraction. Sonography combined with computed tomography can confirm the presence, size, and position of common duct stones under ideal conditions before deciding if and how to treat choledocholithiasis. The sonographer must often battle bowel gas and difficult body habitus to image common duct stones, but it is crucial to document them when possible for proper diagnosis and management.
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