Case Report
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World J Gastrointest Surg. Jun 27, 2013; 5(6): 210-215
Published online Jun 27, 2013. doi: 10.4240/wjgs.v5.i6.210
Topical nitrate drip infusion using cystic duct tube for retained bile duct stone: A six patients case series
Masatoshi Shoji, Hiroshi Sakuma, Yutaka Yoshimitsu, Tsutomu Maeda, Masuo Nakai, Hiroshi Ueda
Masatoshi Shoji, Hiroshi Sakuma, Yutaka Yoshimitsu, Tsutomu Maeda, Masuo Nakai, Hiroshi Ueda, Department of Surgery, Hoju Memorial Hospital, Nomi, Ishikawa 923-1226, Japan
Author contributions: Shoji M, Sakuma H and Yoshimitsu Y designed the report; Shoji M, Sakuma H and Yoshimitsu Y were attending doctors for patients; Maeda T, Nakai M and Ueda H organized the report; Shoji M wrote paper.
Correspondence to: Masatoshi Shoji, MD, Department of Surgery, Hoju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa 923-1226, Japan. pignite@me.com
Telephone: +81-761-515551 Fax: +81-761-515557
Received: April 6, 2013
Revised: May 22, 2013
Accepted: June 1, 2013
Published online: June 27, 2013
Abstract

A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice. An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (EST), followed by stone extraction, are usually an effective treatment for this condition. However, these procedures are associated with severe complications including pancreatitis, bleeding, and duodenal perforation. Nitrates such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN) are known to relax the sphincter of Oddi. In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN, which was the regular dose of intravenous injection. Three other cases failed, and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. One patient developed an adverse event of nausea. Severe complications were not observed. We consider the topical nitrate drip infusion via C-tube to be old but safe, easy, and inexpensive procedure for retained bile duct stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.

Keywords: Nitrate, Topical drip infusion, Cystic duct tube, Retained bile duct stone, Cholecystectomy

Core tip: In 6 cases in which a retained stone was detected following cholecystectomy, topical nitrate drip infusion via cystic duct tube (C-tube) was carried out. Retained stones of 2-3 mm diameter with no dilated common bile duct in 3 patients were removed by drip infusion of glyceryl trinitrate or isosorbide dinitrate. Three other cases failed, and endoscopic sphincterotomy in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed. The topical nitrate drip infusion via C-tube is old but safe, easy, and inexpensive procedure for retained stone following cholecystectomy, inasmuch as removal rate was about 50% in our cases.