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

INTRODUCTION: Extracorporeal 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 CASE: We 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. DISCUSSION: Literature 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. CONCLUSION: Our case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy.