A 73yr old gentleman presented with recurrent episodes of pain abdomen since last 2years. He was admitted elsewhere with Jaundice and Fever. His LFT was deranged. His USG abdomen showed post cholecystectomy status and CBD (Common Bile Duct) was normal. He was suspected to have biliary colic and hence a specialized method MRCP ( MRI evaluation to assess bile and pancreatic duct) was advised. MRCP showed a stone in common bile duct (CBD)causing obstruction. He was resuscitated initially and taken up for ERCP (an endoscopic procedure to clear bile duct blockage). His cholangiogram showed dilated CBD due to obstruction by a large stone with narrow distal CBD .On attempted stone clearance, it was found that stone was getting impacted in narrow distal CBD.

A specialised method called Through the Scope Mechanical Lithotripsy was used to crush the stone. This procedure involves passing a basket attached to a metal wire through the scope into CBD. Once stone is grasped in the basket, stone gets stuck between two metal sides and by applying mechanical pressure it gets mechanically crushed into pieces. CBD clearance was achieved in this patient and plastic stent was placed in CBD for short duration.

He was discharged from hospital on day 2. One week on follow up his LFT was normal and he was pain free. This technique helped us to avoid a major surgery of CBD exploration which would have required prolonged hospital stay and risk of general anaesthesia.