case_images: PMC11712018_01
case_images: Preoperative CT in a 96-year-old female patient with ACC + CBDS. A: Preoperative axial CT image showed a circular (diameter 8 mm, arrow) high-density shadow at the neck of gallbladder, with a bilateral sign on the gallbladder wall; B: a circular (diameter 15 mm, arrow) high-density shadow within the CBD; C: Coronal CT image displayed multiple nodular high-density shadows in the CBD; D: CT three-dimensional (3D) visualization reconstruction image confirmed the smaller high-density shadow at the neck of the gallbladder (red arrow), and the larger high-density shadows in the CBD (blue arrow). ACC: Acute calculous cholecystitis. CT: Computed tomography. CBD: Common bile duct. CBDS: Common bile duct stone.
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case_images: PMC11712018_01_gr1.jpg
case_images: fig1
case_images: Intraoperative images of LC + LTCBDE in the 96-year-old female patient with ACC + CBDS. A: The cystic duct is relatively thin (diameter 5 mm), and the suture needle puncture incision method is used to cut the cystic duct (arrow); B: A choledochoscope (Olympus CHF type 5, Japan) was inserted into the CBD via the cystic duct after dilating the Heister valve (arrow); C: The crushed CBDS (by means of applying pressure and water flushing, pushing and crushing) were removed through the choledochoscopic stone removal basket (arrow); D: Suture the residual end of the cystic duct (arrow); E: The suture site of the residual end of the cystic duct (green arrow), the common hepatic duct (red arrow), and the CBD (black arrow); F: reinforce the suture site of the residual end of the cystic duct with absorbable clip (green arrow), the common hepatic duct (red arrow), and the CBD (black arrow). ACC: Acute calculous cholecystitis. CBD: Common bile duct. CBDS: Common bile duct stone. LC: Laparoscopic cholecystectomy. LTCBDE: laparoscopic transcystic CBD exploration.
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case_images: PMC11712018_01_gr2.jpg
case_images: fig2
case_images: The suture-needle puncture incision method was applied to create a horizontal incision in the anterior wall of the cystic duct at a distance of 1-2 mm away from the CBD (Fig. 2A). Following dilation of the Heister valve, a choledochoscope (Olympus CHF type 5, Japan) was inserted into the CBD via the cystic duct (Fig. 2, Fig. 3A). Fig. 2C). Following the removal of the CBDS, the suture site of the residual end of the cystic duct was reinforced with an absorbable clip after CBDS removal (Fig. 2D-F). Following the complete removal of the CBD stones, neither stenosis was observed in the sphincter of Oddi (Fig. 3C), nor was the residual stone found in the left hepatic duct and right hepatic duct (Fig. 3D).
case_images: Intraoperative choledochoscopy images of LC + LTCBDE in the 96-year-old female patient with ACC + CBDS. A: The process of performing choledochoscopy through the cystic duct (arrow); B: A larger stone at the proximal end of the CBD (arrow); C: After completely removing the CBD stones, no stenosis was observed in the sphincter of Oddi (arrow); D: No stone was found in the left hepatic duct (blue arrow) and right hepatic duct (green arrow).
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case_images: PMC11712018_01_gr3.jpg
case_images: fig3
case_images: The larger stone was identified at the proximal end of the CBD (Fig. 3B). Following the removal of the CBDS, the suture site of the residual end of the cystic duct was reinforced with an absorbable clip after CBDS removal (Fig. 2D-F). Following the complete removal of the CBD stones, neither stenosis was observed in the sphincter of Oddi (Fig. 3C), nor was the residual stone found in the left hepatic duct and right hepatic duct (Fig. 3D).