The Diagnosis and Therapy of Retained Stones and Residual Nasobiliary Drainage Tube in the Common Bile Duct via Endoscope: Report of a Rare Complication

Abstract

Introdution: Foreign body in biliary tract is a rare iatrogenic complication, and the patient usually has a medical history of surgeries in biliary system. The foreign body in biliary tract blocks the biliary tract and induces acute cholangitis and cholecystitis, some become cores and form the common duct stones. The upper abdominal pain can occur repeatedly accompanied by fever, icterrus, nausea and vomiting, and the blood test and liver function turn out abnormal. In combination with medical history, clinical manifestation, type B ultrasound, CT and MRCP, the diagnosis can be confirmed. Generally speaking, surgical treatment is considered as the principle. With the improvement in ERCP technology and endoscopic accessories, the minimally invasive interventional therapy has been further applied. Case presentation: A 72-year old patient, who experienced upper abdominal pain during the hospitalization in our hospital and the diagnosis was confirmed to be cholecystolithiasis and multiple stones in common bile duct after type B ultrasound and CT. The patient underwent ERCP, EST, biliary tract calculus removal and LC surgery. After discharge, the patient intermittently experienced upper abdominal discomfort and dull abdominal pain without fever and icterus. Type B ultrasound and CT: the thin stripped shaped tubular substance and calculus shadows were observed inside common bile duct. Then the patient underwent ERCP, which indicated the residual end of nasobiliary drainage tube of intestinal cavity of descending part of duedenum, the length was about 6 cm, and it was removed using a calculus dislodger. It was difficult to target the residual end of the nasobiliary drainage tube in the common bile duct using a calculus dislodger, so the calculus dislodger was replaced by stone-removing Foley's tube and finally an about 8 cm long residual end of nasobiliary drainage tube was taken out. Conclusion: There are only a few case reports in the literature describing the iatrogenic complications of retained stones and residual nasobiliary drainage in the common bile duct after having ERCP. We describe the diagnosis and therapy of the complications by endoscopy to alert clinician.