Brief:
Chronic Pancreatitis with Advanced Calculous Chronic Pancreatitis with Large Impacted Stone

Description:

• 35/F come to us with chronic pancreatitis
• H/o endotherapy and ESWL attempts followed by surgery for chronic pancreatitis elsewhere. However, despite all this patient continues to have severe pain
• EUS revealed odematous pancreas with dilated MPD and large 15 mm stone impacted in the prepapillary portion, few stones were also seen in genu region with atrophy of the gland.
• Prepapillary stone and concrements were seen exuding out of papilla after sphincterotomy followed by 7 fr stent placement
• Proper pre procedure and pre surgery EUS mapping of disease could have prevented repeat procedures

TAKE HOME MESSAGE

• Patient with risk factors such as tobacco consumption with dysplastic lesions in the esophagus are at very high risk of developing invasive cancers. Timely detection for intraepithelial lesions such as this case, will enable endoscopic curative resection. Importance of magnification and electronic chromoendoscopy can be appreciated in this case

Image:

1.EUS showed large soft stones in MPD

2.Pancreatogram showed stones in the MPD.

3.Ductal clearance has been performed

4.A 7 fr stent placement