Biliary balloon dilator impaction in a non-dilated bile duct with anatomical variations: a case report

While techniques for extracting large stones from dilated bile ducts are increasing, options for small stones impacted in non-dilated bile ducts are limited. We report the case of an impacted biliary balloon dilator in a choledocholithiasis patient with a non-dilated bile duct and multiple anatomical variations, including low insertion of the cystic duct. After unsuccessful attempts with a stone extraction basket and balloon, a biliary balloon dilator with a sharp catheter tip was advanced into the bile duct. The balloon could not be removed from the bile duct even when deflated. The duodenoscope fell back into the stomach, causing the shaft of the dilator to break near the ampulla. We then removed the broken tip with a snare, which caused the balloon sheath to separate from the shaft and remain in the bile duct. Finally, we removed the sheath with rat-tooth forceps, leading to successful extraction of the stone-and-balloon complex. The exceedingly rare possibility of balloon impaction should be kept in mind when using biliary balloon dilators in non-dilated bile ducts.