Modified percutaneous transhepatic papillary balloon dilation for patients with refractory hepatolithiasis

Figure 1 A 58-yr-old man with common bile duct stone and intrahepatic bile duct stone. A: Computed tomography after contrast administration of the common bile duct stone (arrow); B: Computed tomography without contrast of the intrahepatic bile duct stone (arrow).

Figure 2 Cholangiography. A: Cholangiography revealed the location, size, and number of the intrahepatic and common bile duct stones; B: The left bile duct with stones was dilated with a balloon catheter in presence of stenosis; C: The intrahepatic bile duct stone was pushed with a dilated Fogarty catheter; D: Stone was pushed into common bile duct; E: The papilla was dilated; F: Stones in the common bile duct were pushed into the duodenum.

Figure 3 For stones located in the punctured bile duct with no or moderate stenosis, injection of saline through the sheath or a moderately inflated balloon dilation catheter was used to push the stones into common bile duct. A: A stone (arrow) located in the right hepatic bile duct; B: Saline was injected through the sheath and the stone was pushed into the common bile duct (arrow).