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The diagnosis of common bile duct (CBD) stones has usually been made by previous ultrasonography, computed tomography, magnetic resonance imaging, or endoscopic ultrasonography. Nevertheless, in some cases the biliary stones are not clearly visible at endoscopic retrograde cholangiopancreatography, even after multiple passages with a Dormia basket or ballon extractor. This might be explained by possible spontaneous migration of CBD stones or by a quick passage of stones during the extraction maneuver, that precludes their visualization.
The case reported here shows another possible explanation, namely, stone impaction at the orifice of the duct of Wirsung. Prompt recognition and treatment of this occurrence is mandatory to potentially prevent subsequent possible serious complications. Consideration of additional needle-knife papillotomy should be kept in mind as a solution, to the great benefit of our patients.
26 August 2021 (online)
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