Case ReportLessons learnt from a case of extracorporeal shockwave lithotripsy for a residual gallbladder stone

- ECSWL failed to treat a residual gallbladder stone after failed cholecystectomy.
- Even if a stone is fractured, it may not be expelled by a diseased gallbladder.
- ECSWL should be followed by endoscopic retrieval to complete treatment.

IntroductionExtracorporeal shockwave lithotripsy (ECSWL) for gallstones is rarely used due to high recurrence rates, but has been reported to be effective in some circumstances.Presentation of caseWe describe a case of a failed attempt at laparoscopic cholecystectomy due to gallbladder contraction and complete obliteration of Calot's triangle. Cholecystotomy was performed to remove all visible stones, and completed by a subtotal cholecystectomy and closure of the gallbladder remnant. The patient remained symptomatic due to a residual stone in the Hartmann's pouch. ECSWL was attempted to fragment the stone; however, follow-up imaging showed persistence of the calculus.DiscussionLiterature review shows that ECSWL for multiple gallbladder stones has a low success rate. Even if a stone is successfully fragmented, a diseased gallbladder remnant seems incapable of expelling the fragments. Without completion endoscopic clearance, therefore, the treatment is considered incomplete.ConclusionOur case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy.