Elective Cholecystectomy After Biliary Lithotripsy: An Indication for Routine Intraoperative Cholangiography?

To the Editor.—Given the increasing popularity of extracorporeal shock wave biliary lithotripsy and the fact that small stone fragments leave the gallbladder via the common bile duct, the complications of this therapy are now becoming more apparent. We report a case of a patient who underwent elective cholecystectomy after failing biliary lithotripsy. There were no indications of intraoperative cholangiography except the presumption that stone fragments were likely to have traveled down the common bile duct.

Report of a Case.—A 50-year-old Hispanic woman presented with recurrent postprandial right upper quadrant pain and nausea 6 months after undergoing biliary lithotripsy for symptomatic cholelithiasis. These symptoms began 10 years before admission. Prior to lithotripsy, a single 2-cm gallstone was documented sonographically. Her symptoms persisted and she requested surgical treatment. She denied a history of dark urine, acholic stools, jaundice, fever, or chills. Physical examination was significant for a well-appearing anicteric