Endoscopic sphincterotomy is a useful preoperative management for refractory pancreatitis associated with pancreaticobiliary maljunction.
BACKGROUND
Pancreatitis associated with pancreaticobiliary maljunction (PBM) is commonly treated nonoperatively before surgery. It is, however, sometimes uncontrollable, and little has been reported about the management.


METHODS
Focusing on the preoperative management, we reviewed clinical courses of 4 PBM cases (ages 1 to 7 years old). Each had pancreatitis that was totally resistant to medical treatment and was applied endoscopic sphincterotomy (ES).


RESULTS
The first case underwent percutaneous transhepatic catheter drainage (PTCD) primarily. In spite of daily lavage using the drainage tube for a week, plugs located in the common channel were not removed, and clinical findings were not improved. Therefore, ES followed by removal of protein plugs was performed to improve pancreatitis dramatically. Through this experience, 3 subsequent cases with refractory pancreatitis all underwent successful ES primarily soon after the medical treatments turned out to be ineffective. In all 4 cases, protein plugs were impacted in common channels, and ES could successfully remove the plugs that were impossible to remove by using PTCD. Improved preoperative pancreaticobiliary decompression by ES shortens the duration of recalcitrant acute pancreatitis associated with PBM allowing for a subsequent safe operation.


CONCLUSIONS
Endoscopic sphincterotomy is one of the useful preoperative managements for refractory pancreatitis associated with PBM.
Terui
Keita
K
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8677, Japan. kta@cc.rim.or.jp
Yoshida
Hideo
H
Kouchi
Katsunori
K
Hishiki
Tomoro
T
Saito
Takeshi
T
Mitsunaga
Tetsuya
T
Takenouchi
Ayako
A
Tsuyuguchi
Toshio
T
Yamaguchi
Taketo
T
Ohnuma
Naomi
N
D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000002:abnormalities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010183:Pancreatic Ducts / Q000002:abnormalities; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D009803:Sphincter of Oddi / Q000002:abnormalities* / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome