Brief:
Severe Pancreatitis - Of Unknown Etiology

Description:

• 31/F had come to us with recent episode of severe acute pancreatitis of unknown etiology
• All conventional imaging, USG abdomen, CT Scan and MRI was inconclusive of etiology
• EUS revealed multiple imaging microliths and small stones in the gall bladder and CBD. Pancreas appeared edematous with peripancreatic fat stranding in the body and tail region
• Hence Endotherapy was performed and CBD was cleared off stones
• In view of the severity of the acute pancreatitis a NJ tube was then placed across the DJ flexure under endoscopic and fluoroscopic control
• NJ tube should allow enteral nutrition till the pancreatitis settles down.

TAKE HOME MESSAGE

• Patient with acute pancreatitis of unknown etiology should undergo EUS evaluation prior to any other imaging if all biochemistry is inconclusive of etiology.

Image:

1.EUS showed multiple imaging micoroliths and Small stones in the gall bladder and CBD

2.Edematous pancreas with peripancreatic fat standing in the body and tail

3.Selective cannulation of CBD

4.Cholangiogram showed dilated CBD with small stones

5.Biliary sphincterotomy performed

6.A 7fr stent was placed in the CBD