Clin Endosc.  2012 Mar;45(1):99-102. 10.5946/ce.2012.45.1.99.

An Impacted Pancreatic Stone in the Papilla Induced Acute Obstructive Cholangitis in a Patient with Chronic Pancreatitis

• Yoo KH
• Kwon CI
• Yoon SW
• Kim WH
• Lee JM
• Ko KH
• Hong SP
• Park PW

• KMID: 2048840
• DOI: http://doi.org/10.5946/ce.2012.45.1.99

Abstract

Obstructive jaundice is very rarely caused by impaction of a pancreatic stone in the papilla. We report here on a case of obstructive jaundice with acute cholangitis that was caused by an impacted pancreatic stone in the papilla in a patient with chronic pancreatitis. A 48-year-old man presented with acute obstructive cholangitis. Abdominal computed tomography with the reconstructed image revealed distal biliary obstruction that was caused by a pancreatic stone in the pancreatic head, and there was also pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. Emergency duodenoscopy revealed an impacted pancreatic stone in the papilla. Precut papillotomy using a needle knife was performed, followed by removal of the pancreatic stone using grasping forceps. After additional sphincterotomy, a large amount of dark-greenish bile juice gushed out. The patient rapidly improved and he has remained well.

Keyword

Cholangitis; Obstructive jaundice; Pancreatic stone; Chronic pancreatitis; Endoscopic sphincterotomy

MeSH Terms

Atrophy
Bile
Cholangitis
Dilatation
Duodenoscopy
Emergencies
Hand Strength
Head
Humans
Jaundice, Obstructive
Middle Aged
Needles
Pancreatic Ducts
Pancreatitis, Chronic
Sphincterotomy, Endoscopic
Surgical Instruments

Figure

• 

  Fig. 1 Abdominal computed tomographic scanning with the reconstructed image revealed distal biliary obstruction by pancreatic stone in the pancreatic head, pancreatic ductal dilatation and parenchymal atrophy of the pancreatic body and tail with multiple calcifications. The diameter of the impacted stone in the pancreatic head was measured to be about 1 cm.

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  Fig. 2 The computed tomographic scanning with the reconstructive image performed 3 years previously.

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  Fig. 3 The duodenoscopic images. A whitish-yellow stone was exposed at the site of excision by performing precut papillotomy using a needle knife and the stone was removed by grasping forceps.

Reference

1. Moritomo H, Nakaya S, Takeyama Y, et al. A case of obstructive jaundice caused by incarceration of pancreatic stones in the ampulla of papilla Vater. Nihon Geka Gakkai Zasshi. 1990; 91:146–149. PMID: 2314379.

2. Naik A, Shah SH, Relekar RG, Bapat RD. Pancreatic calculus causing obstructive jaundice. Indian J Gastroenterol. 1991; 10:27–28. PMID: 2004800.

3. Little TE, Kozarek RA. Pancreatic stones as a cause of bile duct and ampullary obstruction: endoscopic treatment approaches. Gastrointest Endosc. 1993; 39:709–712. PMID: 8224700.

4. Hernandez JA, Zuckerman MJ, Moldes O. Pancreatic stone presenting with biliary obstruction. Gastrointest Endosc. 1994; 40:521–523. PMID: 7926556.

5. Kinoshita H, Imayama H, Sou H, et al. A case of obstructive icterus caused by incarceration of a pancreatic stone in the common channel of the pancreatobiliary ducts. Kurume Med J. 1996; 43:79–85. PMID: 8709563.

6. Naitoh I, Nakazawa T, Ohara H, et al. A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective. JOP. 2008; 9:520–525. PMID: 18648146.

7. Delhaye M, Arvanitakis M, Bali M, Matos C, Devière J. Endoscopic therapy for chronic pancreatitis. Scand J Surg. 2005; 94:143–153. PMID: 16111097.

8. Scott J, Summerfield JA, Elias E, Dick R, Sherlock S. Chronic pancreatitis: a cause of cholestasis. Gut. 1977; 18:196–201. PMID: 856677.

9. Sarles H, Sahel J. Cholestasis and lesions of the biliary tract in chronic pancreatitis. Gut. 1978; 19:851–857. PMID: 361513.

10. Sarles H, Sarles JC, Camatte R, et al. Observations on 205 confirmed cases of acute pancreatitis, recurring pancreatitis, and chronic pancreatitis. Gut. 1965; 6:545–559. PMID: 5857891.

11. Devière J, Devaere S, Baize M, Cremer M. Endoscopic biliary drainage in chronic pancreatitis. Gastrointest Endosc. 1990; 36:96–100. PMID: 2335299.

12. Adler DG, Lichtenstein D, Baron TH, et al. The role of endoscopy in patients with chronic pancreatitis. Gastrointest Endosc. 2006; 63:933–937. PMID: 16733106.

13. Brand B, Kahl M, Sidhu S, et al. Prospective evaluation of morphology, function, and quality of life after extracorporeal shockwave lithotripsy and endoscopic treatment of chronic calcific pancreatitis. Am J Gastroenterol. 2000; 95:3428–3438. PMID: 11151873.