Abstract: Objective   Exploring the feasibility of the cascade balloon pushing technique for the treatment of residual extrahepatic bile duct stones in the early period (3~4 weeks) after choledocholithotomy T-tube drainage.   Methods   A 72-year-old male patient was admitted to the hospital with the complaint “21 days after T-tube drainage for biliary tract exploration and severe epigastric pain for 10 hours”.After MDT discussion,a digital subtraction angiography-guided T-tube fistula with paralleling balloon pushing was performed under local anesthesia as an emergency treatment.All residual extrahepatic biliary stones were pushed into the duodenum and the T-tube was reintroduced via a guidewire for drainage.  Result   The patient was discharged on the 3rd day after surgery and the T-tube was removed on the 7th day.The sinus tract healed spontaneously and was followed up for 1 month without discomfort.  Conclusion   The cascade balloon pushing technique is feasible for the treatment of residual extrahepatic bile duct stones in the early stages after choledocholithotomy T-tube drainage and can be used as an alternative to return to surgical stone  extraction,trans-T-tube sinusoidal choledochoscopy or trans-endoscopic retrograde cholangiopancreatography for stone extraction.

Key words: choledocholithiasis, balloon pushing, choledocholithotomy, residual stone