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Successful endoscopic removal of a rare, large impacted pancreatic duct stone using grasping forceps: A case report with video.

Abstract As a main complication of chronic pancreatitis (CP), pancreatic duct stones (PDSs) are often associated with ductal obstruction resulting in increasing intraductal and parenchymal pressure and long-lasting pain. There are many methods for removing PDSs. However, for large stones, it is technically difficult to remove them entirely by endoscopic retrograde cholangiopancreatography (ERCP).
PMID
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Authors

Mayor MeshTerms

Surgical Instruments

Keywords
Journal Title medicine
Publication Year Start




PMID- 29620654
OWN - NLM
STAT- MEDLINE
DCOM- 20180416
LR  - 20180416
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 14
DP  - 2018 Apr
TI  - Successful endoscopic removal of a rare, large impacted pancreatic duct stone
      using grasping forceps: A case report with video.
PG  - e0304
LID - 10.1097/MD.0000000000010304 [doi]
AB  - RATIONALE: As a main complication of chronic pancreatitis (CP), pancreatic duct
      stones (PDSs) are often associated with ductal obstruction resulting in
      increasing intraductal and parenchymal pressure and long-lasting pain. There are 
      many methods for removing PDSs. However, for large stones, it is technically
      difficult to remove them entirely by endoscopic retrograde
      cholangiopancreatography (ERCP). PATIENT CONCERNS: A 57-year-old man presented
      with a chief complaint of severe epigastric pain radiating to his back 3 or 4
      times annually for 2 years. DIAGNOSIS: The abdominal computed tomography scan
      revealed dilation of the proximal pancreatic duct with an irregular high-density 
      calcification shadow located at the head of the pancreas. INTERVENTIONS: A
      pancreatic stent was placed initially by ERCP to relieve epigastric pain and
      alleviate symptom. Repeated ERCP was subsequently performed 2 months later to
      extract the impacted large pancreatic stone. OUTCOME: By using grasping forceps, 
      the huge coralloid stone (272 x 0 mm) was successfully extracted in an en bloc
      manner. Then, a 7-French x 5 cm plastic pancreatic stent was placed for 2 weeks. 
      The patient was free of any pancreatic pain during the 2-year follow-up. LESSONS:
      Generally, for large or impacted pancreatic stones, endoscopic removal is
      technically difficult to achieve. Pancreatic stenting can be an effective method 
      of alleviating abdominal pain and facilitating subsequent endoscopic
      lithoextraction. Extraction of large stones with grasping forceps can be an
      alternative approach instead of extracorporeal shock wave lithotripsy or surgery 
      when stones are impacted at the papilla's orifice and partially protruding into
      the duodenal lumen.
FAU - Liu, Qin
AU  - Liu Q
AD  - Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu.
FAU - Wang, Yiping
AU  - Wang Y
AD  - Department of Gastroenterology, Affiliated Cixi People's Hospital, Wenzhou
      Medical University, Ningbo, Zhejiang, China.
FAU - Zeng, Hongze
AU  - Zeng H
AD  - Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu.
FAU - Hu, Bing
AU  - Hu B
AD  - Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Video-Audio Media
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Abdominal Pain/etiology/surgery
MH  - Calcinosis/*surgery
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Humans
MH  - Lithiasis/complications/*surgery
MH  - Male
MH  - Middle Aged
MH  - Pancreas/surgery
MH  - Pancreatic Diseases/complications/*surgery
MH  - Pancreatic Ducts/*surgery
MH  - Pancreatitis, Chronic/complications
MH  - *Surgical Instruments
EDAT- 2018/04/06 06:00
MHDA- 2018/04/17 06:00
CRDT- 2018/04/06 06:00
PHST- 2018/04/06 06:00 [entrez]
PHST- 2018/04/06 06:00 [pubmed]
PHST- 2018/04/17 06:00 [medline]
AID - 10.1097/MD.0000000000010304 [doi]
AID - 00005792-201804060-00032 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(14):e0304. doi: 10.1097/MD.0000000000010304.