Dormia basket retention: When endoscopy fails and surgery is required

Abstract

Background : Endoscopic sphincterotomy performed during ERCP is the reference technique for extracting residual common bile duct stones.

Although generally effective and safe, the procedure carries a risk of iatrogenic complications, which are rare but potentially severe, particularly when using retrieval instruments or hard and impacted stones

Case Presentation : We report the case of Mrs. SD, 58 years old, managed for a cholestatic syndrome due to persistent residual stones one year after laparoscopic cholecystectomy.

Three endoscopic extraction attempts were performed, all unsuccessful, and ultimately resulted in the accidental retention of a Dormia basket within the common bile duct.

Surgical exploration through choledocotomy allowed the extraction of the impacted basket, a plastic stent, and two choledochal stones. Postoperative recovery was favorable.

Duct clearance, integrity, and patency of the common bile duct were confirmed by postoperative cholangiography.

Conclusion : This case illustrates an exceptional iatrogenic complication of the endoscopic sphincterotomy, the complexity of certain choledochal stones, and highlights the limits of endoscopy in the context of hard or impacted stones.  It underscores the importance of early surgical intervention in situations where
instrumental extraction becomes high-risk.