Endoscopic pancreatic duct stent for chronic stricture

Case contributed by Dr Chris O'Donnell

Presentation

Recurrent episodes of acute pancreatitis on a background of chronic epigastric pain

Patient Data

Age: 65
Gender: Male

Plastic stent with distal radio-opaque marker and pigtail projected along the line of the pancreatic duct.

Pancretic duct opens into the distal CBD.  Proximal pancreatic duct is collapsed and obstructed 2-3cms from its opening.  No passage of contrast beyond.

Grossly dilated distal pancreatic duct and side branches with a focal stricture in the head at the site of ERCP obstruction.  No mass lesion or pseudocyst (note a small duodenal diverticulum).

Case Discussion

A consequnce of recurrent pancreatitis is development of duct strictures leading to chronic epigastric pain (especially post prandial) due to an inability of pancreatic exocrine fluids to enter the duodenum.  One treatment albeit temporary is the insertion of a stent as in the biliary tree.

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