title: Solitary main pancreatic ductal calculus of possible biliary origin causing acute pancreatitis.
abstract: BACKGROUND
  Pancreatic ductal calculi are most often associated with chronic pancreatitis. Radiological features of chronic pancreatitis are readily evident in the presence of these calculi. However, acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare.
  
  
  METHODS
  A 59-year-old man presented with a first episode of acute pancreatitis. Contrast enhanced computerized tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) revealed a calculus in the main pancreatic duct in the head of the pancreas causing acute pancreatitis. There were no features suggestive of chronic pancreatitis on CT scanning. The episode acute pancreatitis was managed conservatively. ERCP extraction of the calculus failed as the stone was impacted in the main pancreatic duct resulting in severe acute pancreatitis. Once this resolved, a transduodenal exploration and extraction of the pancreatic ductal calculus was performed successfully. Crystallographic analysis revealed the composition of the calculus was different to that seen in chronic pancreatitis, but more in keeping with a calculus of biliary origin. This could be explained by migration of the biliary calculus via the common channel into the main pancreatic duct. Following the operation the patient made an uneventful recovery and was well at two-year follow up.
  
  
  CONCLUSIONS
  Acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. Failing endoscopic extraction, transduodenal exploration and extraction is a safe option after resolution of acute pancreatitis.
authors.affiliation: Department of Academic Surgery, St. James University Hospital, Leeds, United Kingdom.
authors.forename: Ramakrishna Prasad Chowdary
authors.initials: RP
authors.lastname: Chaparala
authors.forename: Rafiuddin
authors.initials: R
authors.lastname: Patel
authors.forename: James Ahsley
authors.initials: JA
authors.lastname: Guthrie
authors.forename: Mervyn Huw
authors.initials: MH
authors.lastname: Davies
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Guillou
authors.forename: Krishna V
authors.initials: KV
authors.lastname: Menon
mesh_terms: D000208:Acute Disease; D002137:Calculi / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004724:Endoscopy; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010183:Pancreatic Ducts / Q000473:pathology*; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D014057:Tomography, X-Ray Computed