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Case Reports
. 2010:2010:517864.
doi: 10.1155/2010/517864. Epub 2010 May 27.

Endosonography-guided pancreatic duct drainage for chronic pancreatitis: a case report and review

Kei Ito  1 , Naotaka Fujita, Yutaka Noda, Go Kobayashi, Takashi Obana, Jun Horaguchi, Shinsuke Koshita, Yoshihide Kanno
Affiliations
Case Reports

Endosonography-guided pancreatic duct drainage for chronic pancreatitis: a case report and review

Kei Ito et al. Diagn Ther Endosc. 2010.

Abstract

A 50-year-old man was admitted to our department, complaining of epigastric pain and high fever. CT revealed a pseudocyst at the pancreatic head with upstream dilatation of the pancreatic duct (PD) and fluid collection surrounding the pancreas. Endosonography-guided PD drainage (ESPD) was performed because of unsuccessful ERCP. With a curved linear array echoendoscope, a 7.2 F catheter was placed in the PD. Laboratory data showed improvement in a few days and revealed disappearance of the fluid collection. Ten days after ESPD, a 7 F stent was placed in the PD via the puncture tract across the papilla of Vater followed by transpapillary replacement with a 10 F stent. CT showed a reduction in diameter of the PD and disappearance of the pseudocyst. ESPD is a feasible and useful procedure in selected patients with chronic pancreatitis showing stenosis of the main PD when transpapillary approach is impossible.

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Figures

Figure 1
Figure 1
Enhanced CT image. (a) The dilated main pancreatic duct (PD) (arrowhead) and fluid collection (arrow) surrounding the pancreas and the liver were demonstrated. (b) A pseudocyst (arrow) at the pancreatic head was revealed.
Figure 2
Figure 2
Endosonography-guided pancreatic duct drainage (ESPD): (a) endosonographic image, (b, c) X-ray image, and (d) endoscopic image. The PD was punctured via the body of the stomach with a 19-gauge needle (arrow) (a, b). A 7.2 F nasopancreatic duct drainage catheter (arrow) was placed (c, d).
Figure 3
Figure 3
Prograde PD stenting: (a, b) X-ray image. Ten days after ESPD, a guidewire was passed through the papilla of Vater (a). A 7 F stent with a single duodenal pigtail (arrow) was inserted into the PD via the puncture tract (b).
Figure 4
Figure 4
(a) X-ray image, (b) endoscopic image. The stent was transpapillarily replaced with a 10 F straight stent (arrow) one week later.
Figure 5
Figure 5
Enhanced CT image. A reduction in diameter of the PD (arrow) and the disappearance of the pseudocyst were demonstrated.
See this image and copyright information in PMC

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