Endoscopic Extraction of Impacted Stones at Choledochoduodenostomy Site Using Tripod Grasper Forceps: A Rare Case Report

Abstract

A 37-year-old man presented with acute epigastric pain radiating to the back after a heavy meal during military duty, associated with bilious vomiting, fever with chills and rigors, constipation, profuse sweating, and respiratory discomfort. He had undergone cholecystectomy, choledochotomy, choledocholithotomy, and choledochoduodenostomy two months earlier for gallstones, common bile duct (CBD) stones, and intrahepatic duct (IHD) stones. Intraoperatively, some intrahepatic stones could not be extracted due to technical limitations. On current admission, initial conservative management was given for suspected acute gastritis. Ultrasound abdomen revealed pneumobilia without pancreatitis. Esophagogastroduodenoscopy (OGD) surprisingly revealed stone impaction at the choledochoduodenostomy site in the first part of the duodenum (D1). Endoscopic extraction with basket and balloon failed, but successful stone crushing with rat-tooth forceps followed by removal with tripod foreign body forceps retrieved two large stones. The patient improved significantly, with subsequent imaging confirming residual small intrahepatic stones. He was discharged two weeks after admission in stable condition. This case highlights the rare complication of stone impaction at a choledochoduodenostomy site and the therapeutic efficacy of endoscopic intervention.