Laparoscopic pancreatic duct exploration, electrohydraulic shock wave lithotripsy combined with internal drainage for pancreatic duct stones: A case report

Abstract

Introduction: Chronic pancreatitis is characterized by irreversible structural damage, including fibrosis and compression of the pancreatic ducts, often leading to stones forming in the pancreatic duct and parenchyma. Surgery is indicated when severe obstruction with chronic pain is presented and conventionally drained by pancreatojejunostomy.

Case report: A 56-year-old female patient with epigastric pain for many years. Computed tomography revealed an atrophic pancreas with a dilated pancreatic duct (18 mm) obstructed by a stone sized 1.3 cm. The patient underwent laparoscopic pancreatic duct exploration, used electrohydraulic lithotripsy for pancreatic duct stones, and then placed pancreaticoduodenal internal drainage with primary closure of the pancreatic duct. The operative time was 185 min, and the total blood loss was around 50 ml without intraoperative complication. The patient was discharged from the hospital on postoperative day 5 uneventfully. The epigastric pain symptoms dramatically decreased in the follow-up visit after one month.

Clinical discussion: We combined several minimally invasive techniques to treat a chronic pancreatitis patient with a stone forming in the main duct in this patient. We used lithotripsy and internal drainage without the need for anastomosis. To our knowledge, this is the first report on this technique in literature. We found this technique is safe and applicable in selected patients to treat pancreatic stones with the dilated pancreatic duct.

Conclusions: In this case, we demonstrate a novel surgical treatment option for chronic pancreatitis with a simple and effective technique to manage pancreatic stones in chronic pancreatitis patients.

Keywords: Chronic pancreatitis; Laparoscopic surgery; Pancreatic duct stones.

Fig. 1

CT scan imaging: Pancreatic headstone.

Fig. 2

CT scan imaging: Dilated pancreatic duct.

Fig. 3

Lithotripsy system.

Fig. 4

Trocars positions and lithotripsy system.

Fig. 5

Insertion of the catheter into the pancreas.

Figs. 6, 7

Endoscopic images of pancreatic stones and stones after surgery.

Figs. 6, 7

Endoscopic images of pancreatic stones and stones after surgery.

Fig. 8

Insertion of trans pancreatic duct catheter to the duodenum.

Fig. 9

CT scan 3 months after surgery shows no stones left.