Endoscopic transampullar examination of the biliary tract is considered the standard method of treatment for stones in its interior, but it is not effective in all scenarios.

That procedure is successful in stones impacted in the intrahepatic ducts when additional resources are used, such as cholangioscopy and lithotripsy (electrohydraulic or laser), and with the possibility of their repetition, which significantly increases costs.

We describe the case herein of a young man that sought medical attention due to obstructive jaundice and recurrent episodes of cholangitis. Diagnosis was cholelithiasis with multiple stones, one of which was impacted (fig. 1 a,b). Antibiotic therapy was begun and cholecystectomy with laparoscopic examination of the bile ducts was performed using a flexible video-endoscope with a 5.3-mm diameter, a 2-mm working channel, and a Dormia basket (figs. 2 and 3 a-d). Complete stone extraction was achieved. The patient progressed satisfactorily and was released 48h after the procedure. In the case described, cholecystectomy, laparoscopic examination of the biliary tract, and intraoperative cholangioscopy were a cost-effective treatment option.

Figure 1.

Cholangio-NMR: The arrows point to the stone impacted in the right posterior segmental duct and in the common bile duct. a) 3D reconstruction. b) Axial view in T2.

Figure 2.

Laparoscopic dissection of the common bile duct landmarked with sutures (Prolene® 3-0).

Figure 3.

Series showing the steps during the laparoscopic examination of the biliary tract: a) choledocotomy; b) laparoscopic cholangioscopy (impacted intrahepatic duct stone); c) extraction of multiple stones with the Dormia basket; d) cholangioscopy after extraction of the stones.