# A Report of a Rare Case of Choledocholithiasis Complicated by Proximal Basket Rod Rupture Requiring Surgical Intervention

## TL;DR

A rare case of a broken ERCP basket during stone removal led to the need for surgery to clear the bile duct.

## Contribution

This case highlights a rare complication of ERCP and the need for surgical intervention in such scenarios.

## Key findings

- Mechanical lithotripsy caused a Dormia basket rod rupture during choledocholithiasis treatment.
- Surgical intervention was required after failed endoscopic removal of the broken basket and stones.
- A biliary stent was placed temporarily before surgical removal of the device and stones.

## Abstract

We report a rare case of choledocholithiasis in which mechanical lithotripsy led to rupture of the proximal rod of the Dormia basket, complicating the removal of calculi via endoscopic retrograde cholangiopancreatography (ERCP) and necessitating surgical intervention. ERCP plays a key role in the management of biliopancreatic disorders. Although this approach has improved in recent decades, it remains one of the endoscopic procedures with the highest complication rates. These complications may arise due to the presence of large or impacted stones, resulting in excessive stress on the basket wires or rod. Basket impaction may lead to several complications, such as cholangitis, common bile duct (CBD) perforation, and pancreatitis. Therefore, early removal of the impacted device is recommended. However, no ideal technique for its removal has been established. A 34-year-old female patient presented with pain in the upper right quadrant of the abdomen and jaundice, but no fever. Imaging findings revealed cholelithiasis and choledocholithiasis. ERCP showed 10-mm calculi in the proximal segment of the CBD, along with a distal long-segment narrowing. Mechanical lithotripsy was unsuccessful in fragmenting the calculi, and a complication occurred when the proximal rod of the basket broke, making it difficult to remove the basket along with the trapped calculi. A biliary plastic stent was placed. The endoscopist suggested delayed removal of the basket, stone, and stent. Nevertheless, the attending surgeon opted for open surgery two days later, performing a cholecystectomy and removal of the stent, calculi, and basket via duodenotomy.