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Liu Y. et al., 2019: Colonic hematoma after extracorporeal shock wave lithotripsy for pancreatic stones: a case report

Liu Y, Hao L, Wang T, Li ZS, Xu ZL, Hu LH.
Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, 1017 North Dongmen Road, Shenzhen, Guangdong, China.
Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, 800 Xiangyin Road, Shanghai, 200433, China.

Abstract

BACKGROUND:
Despite pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is a minimally invasive treatment for pancreatic stones, complications exist.

CASE PRESENTATION:
A 37-year-old male was diagnosed with chronic pancreatitis and admitted to our hospital for recurrent acute pancreatitis. After the first P-ESWL session, the patient complained of a new type of pain different from the previous pain pattern. Computerized tomography and colonoscopy were arranged and colonic hematoma was found. Since the patient had stable vital signs, no special treatment was given focusing on the colonic hematoma. Five days later, P-ESWL treatment was repeatedly performed for four consecutive days. Two days after the last P-ESWL session, the patient underwent endoscopic retrograde cholangiopancreatography. At the three-month follow up visit, the colonic hematoma disappeared and pancreatic stones decreased significantly.

CONCLUSIONS:
To the best of our knowledge, colonic hematoma after P-ESWL for pancreatic stones has never been reported. Here, we present the only case of colonic hematoma after P-ESWL, which was coincidentally found in more than 6000 P-ESWL sessions in our hospital. As the symptoms of colonic hematoma are mild, we believe the incidence of colonic hematoma has been underestimated. Many people with colonic hematoma after P-ESWL may be undiagnosed or misdiagnosed. Treatment for colonic hematoma depends on whether there is severe clinical state. Exploration of more precise location method for pancreatic stones may reduce the probability of P-ESWL complication.
BMC Gastroenterol. 2019 Dec 4;19(1):208. doi: 10.1186/s12876-019-1117-7.

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Comments 1

Peter Alken on Monday, February 24 2020 08:30

The first case report of a colonic hematoma after EWSL for pancreatic stones.
What I find more astonishing are the postprocedural actions:
“The patient was ordered to fast, lie on bed and reduce activities all day. Fluids were transfused and vital signs were monitored all day. The patient was quite stable … “ 5 days later the patient got four consecutive P-ESWL sessions; “up to 5000 shock waves were delivered at a frequency of 120 shocks/min with an intensity of 6 (16,000 kV) on a scale of 1 to 6.” Quite daring!
I wonder what routine fecal occult blood tests would show after ESWL for renal or ureteral stones.

The first case report of a colonic hematoma after EWSL for pancreatic stones. What I find more astonishing are the postprocedural actions: “The patient was ordered to fast, lie on bed and reduce activities all day. Fluids were transfused and vital signs were monitored all day. The patient was quite stable … “ 5 days later the patient got four consecutive P-ESWL sessions; “up to 5000 shock waves were delivered at a frequency of 120 shocks/min with an intensity of 6 (16,000 kV) on a scale of 1 to 6.” Quite daring! I wonder what routine fecal occult blood tests would show after ESWL for renal or ureteral stones.
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