A large retained stone impacted in the distal com¬mon bile duct is noted when T-tube cholangiography is performed after choledochostomy. The best manage-ment of the stone is
|A||dissolution with sodium cholate|
|B||dissolution with heparin|
|C||catheter extraction via the tract of the T-tube|
|D||transduodenal papillotomy with endoscopic stone extraction|
Use of routine cholangiogram or ultrasound to identify so-called silent common bile duct stones is controversial. Routine intraoperative cholangiography will detect stones in about 7% of patients, outline the anatomy, and identify potential biliary injuries.
Indications for Intraoperative Cholangiogram
As the stone in this patient is impacted it wil not be roved by flushing the t tube.Hence the best approach is transduodenal pappilotomy and endoscopic stone retrival.