A patient with acute gangrenous cholecystitis in whom a choledocholith was removed by the rendezvous method via the PTGBD route

Abstract

An 87-year-old female patient was referred to our hospital with a history of fever and abdominal pain. Abdominal CT revealed a gallbladder stone, findings suggestive of cholecystitis, and a choledocholith. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) . Eight days later, CT showed a thinned gallbladder wall, a pericholecystic abscess and a diverticulum-like prominence. We diagnosed acute gangrenous cholecystitis and performed percutaneous transhepatic gallbladder drainage (PTGBD) . After the cholecystitis improved, we performed endoscopic retrograde cholangiopancreatography (ERCP) to remove the stone. The papilla was located in a duodenal diverticulum. Therefore, we could not cannulate the common bile duct (CBD) , and performed endoscopic choledocholithotomy by the rendezvous method via the PTGBD route. A guidewire was introduced into the duodenum via the papilla and the bile duct intubation was successful.
The choledocholith was removed with a mechanical lithotripter after endoscopic sphincterotomy.
The rendezvous method via the PTGBD route is useful when selective cannulation of the CBD is difficult due to the presence of a duodenal diverticulum.