Using Cholangioscopy with Electrohydraulic Lithotripsy to Remove a Difficult Common Bile Duct Stone by Dr. Friend, CGH Medical Center, Sterling, Illinois, U.S.A.

The patient, a 78-year-old female, was admitted to the hospital through the Emergency Department for elevated liver function tests and dark-colored urine that had been getting increasingly darker for the past several days. The patient has a past medical history of metastatic squamous cell carcinoma to the left inguinal node, diagnosed approximately two and a half years ago, for which the primary source was not identified. She refused chemotherapy and radiation and just wanted active surveillance. The patient had no significant abdominal pain, but reported some nausea and dry heaving as well as headaches while at home. Liver function tests were elevated with a total bilirubin of 3.69 with mostly direct of 2.9, alkaline phosphatase 367, AST 182, ALT 242, and total protein 8.3. The patient’s AFP tumor marker was 1.4 and CA 19-9 was 1.