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Create a Free AccountAnatomy - Hepatopancreatobiliary
Laparoscopic intraoperative pancreatoscopy for main duct intraductal papillary mucinous neoplasms assessment
Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are increasingly diagnosed tumors that are characterized by endoluminal papillary projections of mucin-producing ductal epithelium, leading to a dilatation of the ducts it develops within. IPMNs carry a high risk of malignancy when the main pancreatic duct is involved (MD-IPMNs). When feasible, surgical resection of the pancreatic segment involved is the therapeutic option of choice. Complete resection of IPMN lesions is essential and requires precise diagnosis of the extent of the disease.Endoscopic ultrasound-guided pancreaticoduodenostomy with a forward-viewing echoendoscope
A 76-year-old man with distal bile duct cancer was treated by endoscopic transpapillary self-expandable metallic stent placement and hospice care. He had undergone liver resection for hepatocellular carcinoma 4 years prior. He presented with sudden-onset epigastric pain and vomiting. CT revealed a main pancreatic duct (MPD) stricture in the head of the pancreas, and upstream ductal dilation (Fig. 1). A blood test revealed elevated pancreatic enzymes (amylase 554, lipase 781), and he was diagnosed with acute pancreatitis secondary to malignant pancreatic duct obstruction.Extracorporeal rendezvous technique combining endoscopic retrograde pancreatography with endoscopic ultrasound for main pancreatic duct disconnection arising from acute necrotizing pancreatitis: a case report
A 45-year-old man with a history of heavy alcohol consumption presented with hematemesis and abdominal pain. Serum amylase and C-reactive protein levels were elevated in his biochemical examination. A CT of his abdomen demonstrated an acute necrotic collection around the pancreas (Fig. 1), and EGD demonstrated fistula in the duodenal bulb. Therefore, he was diagnosed with acute pancreatitis with duodenal fistula. He underwent emergency Billroth II gastrectomy and had a percutaneous drainage tube placed near the head of the pancreas.Pancreatic stones treated via an EUS-guided pancreaticogastrostomy with a fully-covered self-expandable metal stent
A 42-year-old man who had undergone a distal pancreatectomy 2 years earlier for chronic pancreatitis due to alcohol, with pancreatic stones, presented because of severe abdominal pain. Blood tests revealed elevated inflammatory markers (white blood cells: 8570/uL; C-reactive protein: 20.1 mg/dL) and pancreatic enzymes (amylase: 273 U/L; lipase: 340 U/L). CT depicted pancreatic stones up to 1 cm in size in the entire pancreatic parenchyma and main pancreatic duct (MPD) (Fig. 1). Obstructive pancreatitis caused by pancreatic stones was diagnosed.Uncommon cause of cholangitis due to a migrated pancreatic stone into the common bile duct
A 62-year-old man was referred to our tertiary hospital for endoscopic therapy of previously diagnosed alcoholic chronic pancreatitis. In the previous year he had been admitted to the referring hospital every 2 months for flares of pancreatitis, which were all treated conservatively. He was using nonopioid analgesics. He had no history of a cholecystectomy. Routine laboratory tests did not show any abnormalities. Cross-sectional imaging studies demonstrated 2 obstructive pancreatic duct stones in the pancreatic head with upstream main pancreatic duct dilatation of 7.6 mm.Peroral pancreatoscopy via the minor papilla in the diagnosis of intraductal papillary mucinous neoplasm
Peroral pancreatoscopy (POPS) helps in the diagnosis of pancreatic disease, but the bending and narrowing of the main pancreatic duct (MPD) via the major papilla can present challenges occasionally.1-3 In such cases, surgeons can approach the MPD via the minor papilla. Most cases of endoscopic minor papilla sphincterotomy (EMPS), however, are for papillary sphincter dysfunction or pancreatic duct divisum.2 Here, we outline how POPS via the minor papilla was used to diagnose recurrent acute pancreatitis due to a main-duct intraductal papillary mucinous neoplasm (MD-IPMN).Endoscopic treatment of large impacted pancreatic ductal stone using digital pancreatoscopy and electrohydraulic lithotripsy
Patients with chronic pancreatitis can develop pancreatic duct stones. These stones can be asymptomatic when they are small or located in the pancreatic parenchyma, but they can cause problems when they are large enough to obstruct the pancreatic duct, causing worsening abdominal pain, exacerbation of pancreatitis, or both.
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