1/10. Endoscopic pancreatic sphincter balloon dilation for effective retrieval of pancreatic duct stone.To facilitate pancreatic stone retrieval, four patients with chronic pancreatitis and pancreatic stones underwent endoscopic pancreatic sphincter balloon dilation (EPSBD) rather than pancreatic sphincterotomy. Extracorporeal shock wave lithotripsy combined with endoscopic removal was carried out in three patients. Stone removal following EPSBD was completely successful in all four patients. patients showed no severe complications during the dilation procedure. In one patient, to prevent pancreatitis, an endoscopic nasopancreatic drain was placed for 1 week after EPSBD. Compared with pancreatic sphincterotomy, EPSBD can be performed safely in patients with chronic pancreatitis to assist in the extraction of pancreatic duct stones. Use of the EPSBD procedure in cases of chronic pancreatitis provides a useful approach to improve endoscopic clearance of pancreatic duct stones.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/10. Endoscopic extraction of an ejaculatory duct calculus to treat obstructive azoospermia.Calculous obstruction of an ejaculatory duct is an uncommon cause of azoospermia or low-volume oligospermia in the infertile man. We report the case of a 32-year-old man with azoospermia, low ejaculate volume, and transrectal ultrosonography (TRUS) findings of bilateral seminal vesicle distention. On cystoscopy for planned transurethral resection of the ejaculatory ducts, a calculus obstructing the right ejaculatory duct at the verumontanum was discovered and removed. Three months later, semen analysis showed improvements in volume, sperm concentration, and sperm motility. An ejaculatory duct calculus should be included in the differential diagnosis of obstructive azoospermia or low-volume oligospermia. magnetic resonance imaging or TRUS may be advisable to identify ductal calculi.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
3/10. Transduodenal extended sphincteroplasty and removal of ventral duct pancreatic calculi.The surgical treatment of chronic pancreatitis and associated ductal calculi typically involves drainage of the main pancreatic duct or parenchymal resection. Treatment of isolated symptomatic pancreatic duct calculi is usually approached by endoscopic techniques. Herein is described a case report of operative transduodenal extraction of symptomatic pancreatic calculi of the ventral pancreas in a patient with a prior distal pancreatectomy. This case represents an uncommon yet valuable option in selected patients in whom endoscopic treatments have failed or are unavailable.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/10. Solitary main pancreatic ductal calculus of possible biliary origin causing acute pancreatitis.CONTEXT: Pancreatic ductal calculi are most often associated with chronic pancreatitis. Radiological features of chronic pancreatitis are readily evident in the presence of these calculi. However, acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. CASE REPORT: A 59-year-old man presented with a first episode of acute pancreatitis. Contrast enhanced computerized tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) revealed a calculus in the main pancreatic duct in the head of the pancreas causing acute pancreatitis. There were no features suggestive of chronic pancreatitis on CT scanning. The episode acute pancreatitis was managed conservatively. ERCP extraction of the calculus failed as the stone was impacted in the main pancreatic duct resulting in severe acute pancreatitis. Once this resolved, a transduodenal exploration and extraction of the pancreatic ductal calculus was performed successfully. Crystallographic analysis revealed the composition of the calculus was different to that seen in chronic pancreatitis, but more in keeping with a calculus of biliary origin. This could be explained by migration of the biliary calculus via the common channel into the main pancreatic duct. Following the operation the patient made an uneventful recovery and was well at two-year follow up. CONCLUSION: Acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. Failing endoscopic extraction, transduodenal exploration and extraction is a safe option after resolution of acute pancreatitis.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
5/10. Extracorporeal shock wave lithotripsy of pancreatic duct stones.Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extracorporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted pancreatic duct stones. An electromagnetic lithotriptor (Siemens Lithostar, Erlangen, FRG) was used. patients were treated in prone position under fluoroscopic control. A mean of 6,813 shock waves (range 1,500-10,000) was delivered in one or two sessions. Disintegration of stones was achieved in 6/8 patients, initial relief of pain in 7/8 patients, and total clearance of the pancreatic duct in 3/8 patients. One patient had an exacerbation of her pancreatitis one day after ESWL, which resolved rapidly with medical treatment. No other complications were observed. Four of five patients with fragmented stones had no abdominal complaints at follow-up (mean 17 months, range 3-27). Three patients in whom ESWL was not completely successful (two without and one with partial fragmentation) underwent an operation according to Puestow. Two of them still have abdominal complaints after surgery. From these data, we conclude that ESWL of pancreatic duct stones is a promising new alternative for surgery, when endoscopic stone extraction fails.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/10. Pancreatic duct calculi. Treatment by pulsed dye laser.Endoscopic sphincterotomy with stone extraction has been successful in the majority of patients with biliary stones; however, large biliary stones and pancreatic stones in the smaller pancreatic duct may require a new approach. Pulsed dye laser has proven effective in treating pancreatic duct calculi during ERCP. With an outpatient procedure to eliminate pancreatic duct calculi, patients can be treated safely and effectively without major surgery. The procedure is less invasive for the patient, thereby reducing morbidity and expense.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/10. Extracorporeal shock wave lithrotripsy of intrahepatic stones. Case presentation and review of the literature.Primary hepatolithiasis, although rare, is a difficult condition requiring the combined management of radiology and surgery. Use of extracorporeal shock wave lithotripsy and percutaneous stone extraction, along with improved biliary drainage by choledochojejunostomy, should provide a safe effective approach to this unusual problem.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/10. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.We report the case of a 33-year-old woman with chronic calcifying pancreatitis in whom an intraductal pancreatic stone with a diameter of 8 mm was successfully disintegrated with extracorporeal shock waves, permitting subsequent endoscopic extraction of the fragments. The patient had a mild attack of pancreatitis after the treatment. We conclude that shockwave lithotripsy of a pancreatic duct stone in patients with chronic pancreatitis is possible. It should, however, be viewed with reservation until further experience has been gained.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/10. Floating pancreatic duct concrements in chronic pancreatitis. pain relief by endoscopic removal.This report describes 3 patients with chronic relapsing pancreatitis, floating pancreatic duct concrements between 4 and 6 mm in diameter, moderate to advanced ductal changes, and repeated severe attacks of pain during acute relapses over a period of several months. Immediate relief of pain was achieved in all 3 patients by endoscopic papillotomy aimed at widening the main pancreatic duct and subsequent extraction or spontaneous passage of pancreatic duct concrements. On the basis of our experience with the patients presented here, endoscopic papillotomy widening the main pancreatic duct may be useful in some patients with chronic pancreatitis and floating pancreatic duct concrements.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/10. Small bowel obstruction secondary to enterolith impaction complicating jejunal diverticulitis.A case of small bowel obstruction secondary to enterolith impaction in the presence of jejunal diverticular disease is described. Only 27 cases of small bowel obstruction by enterolith expelled from small bowel diverticula have been reported in the literature. The reported incidence of jejunal diverticulosis in the general population ranges from 0.02 to 7.1%. Most patients are asymptomatic, but 10% develop complications requiring surgical intervention. Surgical treatment is an enterotomy and stone extraction or manually crushing and milking the stone distally into the colon. Small bowel resection and anastomosis or laparoscopic-assisted small bowel resection are indicated for the treatment of diverticulitis, bowel perforation, or multiple diverticuli. Jejunal diverticular disease should be considered in the differential diagnosis of mechanical small bowel obstruction without an obvious cause, especially in the elderly population.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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