title: A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective.
abstract: BACKGROUND
  Obstructive jaundice in chronic pancreatitis is generally caused by stenosis of the bile duct in the pancreas. Obstructive jaundice caused by the impaction of a pancreatic stone in the papilla is markedly rare, with only seven cases reported to date.
  
  
  METHODS
  We report a case of obstructive jaundice caused by the impaction of a pancreatic stone in the papilla. A 41-year-old male with chronic pancreatitis was admitted because of epigastric pain. Blood analysis revealed increased levels of hepatobiliary system enzymes, mild jaundice and an increase in pancreatic enzymes. Computed tomography revealed a number of pancreatic stones in the main pancreatic duct, and a stone with a diameter of about 1 cm in the pancreatic head. Swelling of the papilla was observed using duodenoscopy while endoscopic ultrasonography revealed a strong echo with acoustic shadows in the papilla. Percutaneous transhepatic biliary drainage was performed for the obstructive jaundice. Contrast medium from the percutaneous transhepatic biliary drainage route regurgitated into the pancreatic duct and revealed the impaction of pancreatic stones in the common channel. The patient was referred to our hospital for treatment of the stone impaction. We performed a needle knife precut papillotomy and extracted a white stone which was diagnosed as a pancreatic stone by composition analysis.
  
  
  CONCLUSIONS
  Impaction of a pancreatic stone in the papilla is a markedly rare cause of obstructive jaundice in chronic pancreatitis. A needle knife precut papillotomy was effective in removing the impacted pancreatic stone in the papilla.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ando
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Okumura
authors.forename: Shozo
authors.initials: S
authors.lastname: Togawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kitajima
authors.forename: Tessin
authors.initials: T
authors.lastname: Ban
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ueno
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sano
mesh_terms: D000328:Adult; D002137:Calculi / Q000150:complications* / Q000000981:diagnostic imaging; D002758:Cholangiography; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000150:complications*; D016717:Sphincterotomy, Endoscopic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome