Use of a double pigtail ureteral stent for surgical management of obstructive pancreatolithiasis in a feline patient

Abstract

Case summary: A 7-year-old castrated male domestic shorthair cat was presented for surgical intervention for obstructive pancreatolithiasis. The patient had a history of chronic weight loss, vomiting and lethargy. Elevation of feline pancreas-specific lipase and a marked decrease in cobalamin were documented on blood biochemistry. Abdominal ultrasound revealed an enlarged right pancreatic limb with a dilated central duct and multiple pancreatoliths visualized within, consistent with partial pancreatic duct obstruction. The patient was successfully treated with a minor duodenal papilla construction using a 2.5 Fr double pigtail ureteral stent.

Relevance and novel information: Pancreatolithiasis is an exceptionally rare condition in veterinary medicine, particularly in cats, with only a few reported cases. Given its low incidence, there is no established consensus regarding the best therapeutic options in clinical practice. This case report outlines the successful application of a locking loop catheter to re-establish the patency of a pancreatic duct. Notably, this is the first documented use of this technique for the surgical management of obstructive pancreatolithiasis.

Keywords: Pancreatolith; chronic pancreatitis; double pigtail ureteral stent; feline pancreatitis; feline pancreatolithiasis; obstructive pancreatolithiasis; pancreatic stones.

Figure 1

Weight trend graph illustrates a progressive decline in weight before surgical intervention, followed by an increase in body weight postoperatively

Figure 2

Preoperative ventrodorsal thoracic radiograph. Multiple, various sized, mineral opacities are seen in the cranial abdomen

Figure 3

Preoperative right lateral abdominal radiograph. Multiple, various sized, mineral opacities are visible ventral to the stomach

Figure 4

Abdominal ultrasound image of the right limb of the pancreas containing calculi characterized by multiple hyperechoic, shadowing structures (pancreatic calculi)

Figure 5

Abdominal ultrasound image depicts the markedly dilated pancreatic duct filled with anechoic fluid with rounded hyperechoic, shadowing structures (pancreatic calculi)

Figure 6

Schematic representation of the surgical technique used to place the double pigtail ureteral stent. (a) A 20 G over-the-needle catheter was inserted normograde through the incision at the dilated accessory pancreatic duct. (b) A wire was passed through the catheter. (c) A 2.5 Fr double pigtail ureteral stent was passed over the wire and guided through the newly established minor duodenal papilla and into the pancreatic duct. (d) The stent was sutured in place within the pancreatic duct and within the duodenal lumen; the duodenal and pancreatic ductal insertions were then sutured closed. A = major duodenal papilla; B = minor duodenal papilla and site of obstruction; C = duodenotomy; D = incision into the accessory pancreatic duct; E = over-the-needle catheter

Figure 7

Postoperative right lateral abdominal radiograph. Multiple, various sized, mineral opacities (pancreatoliths) are visible ventral and caudal to the stomach. The double pigtail ureteral stent is visible in the cranial to mid-abdomen

Figure 8

Postoperative ventrodorsal abdominal radiograph. The double pigtail ureteral stent is visible in the cranial, mid-abdomen, extending to the right lateral abdomen. Numerous mineral opacities (pancreatoliths) of varying sizes can be observed in the cranial abdomen