Successful Endoscopic Treatment of Accessory Pancreatic Duct Stones in an Elderly Patient with Igg-4 Related Disease: A Case Report and Literature Reviews

Abstract

A 93 year old patient who had an acute pancreatitis caused by the obstruction of the pancreatic duct stone is described in this study. He had a history of Ig G 4-related disease and refused to accept steroid therapy. Abdominal CT and MRCP imagines showed that multiple calculi were located in the pancreatic and the pancreatic duct was stretched. The patient underwent Endoscopic Retrograde Cholangiopan-creatography detection after a multidisciplinary consultation. Yet, the catheter can't be inserted into the major pancreatic duct owning to the hyperemia of duodenal papilla, although endoscopic sphincterotomy was performed. Fortunately, The minor duct was cannulated with a standard sphincterotome, and a sphincterotomy was performed followed by successful extraction of the pancreatic stone(1.0×0.8 cm). Since then the patient had no epigastric pain and had a good quality of life. Three years later, he came to our department again for diarrhea. Pancreatic enzyme treatment of diarrhea associated with the chronic pancreatitis was very effective for the patients.