Multidisciplinary collaboration in treatment of obstructive jaundice secondary to large biliary staghorn stone in a Nigerian: A case report

Abstract

The increasing local deployment of minimally interventional radiology procedures as therapy for benign and malignant causes of  obstructive jaundice in Nigeria is noteworthy. The procedures, however, have limitations. This report details an innovative multi-specialist  approach to one such drawback. In our report, following a successful cholangiogram, sphincteroplasty was not possible for the removal  of a large common hepatic duct staghorn calculus and multiple stones proximal to it. As standard cholangioscopic lithotripsy equipment  was not available, recourse was made to the expertise of a urologist who deployed a flexible digital ureteroscope to fragment the large  stone with thulium laser under direct cholangioscopic vision. This facilitated the removal of the said stone the other smaller proximal  stones with no complications and prompt reversal of the clinical presentation of the patient. We highlight this case to show the  significance and role of creative and collaborative thinking in the care of high-end minimally invasive procedures in our resource-limited  locality.