Basketing a Basket: A Novel Emergency Rescue Technique

Fracture of the central lead wire of an impacted basket during a mechanical lithotripsy for large common bile duct (CBD) stones poses a special challenge. Different maneuvers have been described to resolve this problem. Most techniques require equipment or facilities which may not be readily available in small community hospitals. We present here a similar situation in a patient with a large stone at the level of the cystic duct. Through the duodenoscope, a smaller Dormia basket was introduced into the CBD along the side of the impacted broken basket. The tip of the impacted basket was grasped and, by pulling downwards, the basket was disengaged from the stone. The two baskets were then removed successfully. We suggest this simple technique should be tried initially, before resorting to more advanced procedures.