The Cystoscope – An Alternative Choledochoscope for Open Operative Bile Duct Stones Localization and Removal

Abstract

Background: Large bile duct stones removal is a problem.  It has been reported that the impact of open choledochoscopy for reducing the rates of missed stones after Common Bile Duct (CBD) stone clearance. Aim: To highlight an alternative way to visualize the bile duct intraoperatively using a cystoscope as a choledochoscope. Case Presentation: A 30-year-old female presented in the department of Gastrointestinal and Hepatopancreatobiliary Surgery, Jagjivan Ram Hospital, Mumbai Central, Mumbai, India with obstructive jaundice and cholangitis. She had a past history of laparoscopic cholecystectomy in the year 2013 and an open Common Bile Duct (CBD) exploration for stones in the year 2019. Recent imaging studies showed a large stone in the distal CBD. Endoscopic Retrograde Cholangiopancreatography (ERCP) stone removal and CBD stenting attempt was unsuccessful. During the Open CBD exploration (OCBDE), the stone had slipped into the left hepatic duct and was finally localized and removed using a cystoscope as a ‘choledochoscope’. The cystoscope is a useful alternative for localization and removal of bile duct stones in the absence of a choledochoscope. With this in mind, the case report also highlights the role of choledochoscopy for locating the slipped stone(s) and confirming stone clearance. Conclusion: Cystoscope as a choledochoscope is useful for locating the slipped stones and preventing missed stones in OCBDE.