Abstract
A case of hepatolithiasis with impacted stones in the caudate bile duct (B1) that were demonstrated by ultrasonography (US) and endoscopic ultrasonography (EUS), was reported. The patient was a 44-year-old male with a complaint of upper abdominal pain. US and chlangiography via the percutaneous trashepatic cholangial drainage cathter revealed stones in the superior posterior (B6) and inferior posterior (B7) bile ducts of the liver. In addition, impacted stones in the left B1 (B1 1) were demonstrated by percutaneous transhepatic cholangioscopy (PTCS). These stones were removed successfully by electrohydraulic lithotripy under PTCS. Following US and EUS showed a patent picture of the B1 1, however, they detected another stone-retaining Bl branch which proved to be the right B1 (Blr). On PTCS, a strictured orifice of the Blr was found on the posterior wall of the B6. Lithotripsy in this duct was only partly successful because of the narrowed orifice and tortuous ductal running. It has been a general belief that the Bl is not easy to observe by US or EUS. Our experience, however, suggests a possibility of idetifying this duct with or without stones.
