Acute pancreatitis following choledochoscopic stone extraction for hepatolithiasis.
BACKGROUND
Hepatolithiasis is prevalent in Southeast Asia and presents a difficult treatment problem. The main purposes of treatment are clearance of the stones and elimination of bile stasis. Acute pancreatitis due to migratory gall bladder stone is a well documented phenomenon. To the best of our knowledge, there is no previous report of acute pancreatitis due to intrahepatic stone. We report an intriguing case of acute pancreatitis subsequent to postoperative choledochoscopy for residual intrahepatic stone.


METHODS
The patient, a 56-year-old male, suffered from intermittent epigastralgia for about 2 years. Endoscopic retrograde cholangiopancreatography (ERCP) performed after admission showed incomplete contrast filling of the right intrahepatic duct. The patient underwent surgical intervention with the diagnosis of right intrahepatic stones. Postoperative T-tube cholangiography demonstrated impacted right intrahepatic stones behind the stricture. Postoperative matured T-tube tract ductal dilatation (2-4) was begun about 4 weeks after the operation. Choledochoscopy was performed after dilatation. After the third postoperative choledocoscopy for residual stone extraction, the patient complained of abdominal pain the next day. Abdominal CT showed distal common bile duct stone and acute pancreatitis. After medical treatment, patient recovered


CONCLUSIONS
Extrahepatic ductal migration with resultant acute pancreatitis is possible in patients with hepatolithiasis. The awareness of such a possibility enables clinicians to promptly recognize and appropriately manage this kind of acute pancreatitis.
Sheen-Chen
Shyr-Ming
SM
Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, College of Medicine, Chang Gung University, Taiwan. smsheen@yahoo.com
Eng
Hock-Liew
HL
D000208:Acute Disease; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000601:surgery*; D004106:Dilatation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome