Daniel Paramythiotis et al., 2024: Pancreatolithiasis: Does Management Depend on Clinical Manifestations?
Daniel Paramythiotis 1 , Eleni Karlafti 2 , Angeliki Sevasti Kollatou 1 , Theodora Simou 3 , Xanthippi Mavropoulou 4 , Elisavet Psoma 4 , Vasileios Rafailidis 4 , Angeliki Papachristodoulou 4 , Nikoletta Pyrrou 4 , Aristeidis Ioannidis 1 , Stavros Panidis 1 , Antonios Michalopoulos 1
11st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
2Department of Emergency, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
31st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki,, Thessaloniki, Greece.
4Department of Clinical Radiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Abstract
BACKGROUND Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. CASE REPORT We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. CONCLUSIONS The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated.
Am J Case Rep. 2024 Apr 14:25:e942725. doi: 10.12659/AJCR.942725. PMID: 38615191
PMCID: PMC11025692
Comments 1
This report is of no specific interest to urologists because none of the patients was treated with SWL. The need of personalized treatment is emphasized, but SWL is mentioned only in the DISCUSSION.
One aspect that is put forward is that SWL is expensive and requires anesthesia. That conclusion is not correct in a general perspective, but for none of the two patients with pancreas stones presented in this report did SWL seem to be an alternative!
The interesting factors mentioned in the DISCUSSION are that the American Society of Gastrointestinal Endoscopy (ASGE) recommends endoscopy as first line treatment. In contrast the European Society of Gastrointestinal Endoscopy (ESGE) suggests SWL as first line approach. SWL is recommended for stones > 5 mm in diameter.
Hans-Göran Tiselius