Combined minimaly invasive surgery of pancreaticolithiasis in combination with congenital stricture of the terminal sections of the pancreatic ducts

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Abstract


Chronic pancreatitis with pancreatic hypertension is extremely rare in childhood. Chronic pancreatitis in this age is usually always associated with a сongenital defect of the pancreatic duct system. The article describes the case of long-term clinical observation and minimally invasive treatment of chronic calculous pancreatitis, first diagnosed in a girl at the age of 16 years. Despite the fact that clinical manifestations were observed from the age of 3 years, the correct diagnosis could be made only at the age of 16, by joint application of ultrasound, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP). The cause of chronic pancreatitis were concrements and strictures of the main and additional pancreatic ducts that caused pancreatic hypertension. Attempt of endoscopic retrograde lithoextraction from the pancreatic ducts was impossible because of the presence of severe stricture. Therefore, it was decided to apply a combined approach using percutaneous access under ultrasound navigation. The patient underwent series of minimally invasive combined procedures including the lithoextraction, balloon dilatation and transcutaneous drainage of the pancreatic ducts with the endoscopic and percutaneous access with ultrasound and radiologic control. For the prevention of restenosis, the antegrade stenting of the main pancreatic duct with self-expanding coated nitinol stent was used with further removal of the stent. Due to the treatment, there was no pancreatitis within 5 years after stent removal.


Mikhail P. Korolev

Author for correspondence.
korolevmp@yandex.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Dr Med Sci, Professor, Head, Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

Leonid E. Fedotov

fedotov-le@yandex.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Dr Med Sci, Professor, Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

Ruben G. Avanesyan

av-ruben@yandex.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

MD, PhD, Associate Professor, Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

Elena A. Mikhailova

mariinka.hosp@gmail.com
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

Georgiy M. Lepekhin

lepekhingeorge04@rambler.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

Mikhail M. Turyanchik

tur-mixail@mail.ru
St. Petersburg State Pediatric Medical University
Russian Federation, St. Petersburg

Department of General Surgery and Endoscopy with Courses of Care for Surgical Patients

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Copyright (c) 2017 Korolev M.P., Fedotov L.E., Avanesyan R.G., Mikhailova E.A., Lepekhin G.M., Turyanchik M.M.

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