title: Pancreatic Calculus Causing Biliary Obstruction: Endoscopic Therapy for a Rare Initial Presentation of Chronic Pancreatitis.
abstract: BACKGROUND
  Biliary obstruction in chronic calcific pancreatitis (CCP) is often caused by inflammatory or fibrotic strictures of the bile duct, carcinoma of head of pancreas or less commonly by compression from pseudocysts. Pancreatic calculi causing ampullary obstruction and leading to obstructive jaundice is extremely rare.
  
  
  METHODS
  The medical records of all patients with CCP or biliary obstruction who underwent endoscopic retrograde cholangiopancreatography (ERCP) over 4 years between 2010-2014 at Kasturba Medical College, Manipal were analyzed.
  
  
  RESULTS
  Five patients of CCP with impacted pancreatic calculi at the ampulla demonstrated during ERCP were identified. All 5 presented with biliary obstruction and were incidentally detected to have CCP when evaluated for the same; 3 patients had features of cholangitis. All the patients were managed successfully by endoscopic papillotomy and extraction of pancreatic calculi from the ampulla with resolution of biliary obstruction.
  
  
  CONCLUSIONS
  Pancreatic calculus causing ampullary obstruction, though very rare, should be considered as a possibility in patients with CCP complicated by biliary obstruction. Endoscopic therapy is affective in the resolution of biliary obstruction in such patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, 576 104, Karnataka, India.
authors.forename: Anurag J
authors.initials: AJ
authors.lastname: Shetty
authors.forename: C Ganesh
authors.initials: CG
authors.lastname: Pai
authors.forename: Shiran
authors.initials: S
authors.lastname: Shetty
authors.forename: Girisha
authors.initials: G
authors.lastname: Balaraju
mesh_terms: D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002137:Calculi / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic; D014056:Tomography, X-Ray; D055815:Young Adult