An unusual case of recurrent acute pancreatitis successfully treated via precut papillotomy (with video)

Abstract

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Here we report a rare case of recurrent acute pancreatitis in a 34-year-old man caused by pancreatic stone impaction at the minor papilla rather than pancreas divisum (PD). Initial magnetic resonance cholangiopancreatography identified PD without pancreatic stones [Figure 1], but subsequent EUS revealed a protruding minor papilla and complete PD, with a 5 × 3-mm pancreatic stone impacted at the orifice of the dorsal pancreatic duct and diffuse ductal dilation [Figure 2]. Cannulation of minor papilla under endoscopic retrograde cholangiopancreatography failed, and the whitish stone was found embedded within the minor papilla [Figure 3]. A dual-knife papillotomy on minor papilla at the 12-o’clock position was used, exposing the impacted pancreatolith [Figure 4]. Precut papillotomy of minor papilla in the 4-o’clock direction was additionally performed, and the stone was successfully removed [Video 1]. The dorsal pancreatic duct was then cannulated easily, and a pancreatic stent was inserted into the duct for drainage. No postoperative complications occurred. Over 6 months of follow-up, the patient’s quality of life remained good.

This case also highlights that EUS has a superior diagnostic accuracy over magnetic resonance cholangiopancreatography for recurrent acute pancreatitis etiologies,^[1]^ and the dual-knife precut papillotomy technique is safe and effective in such clinical conditions.^[2]^

Supplementary Videos

Video 1. Endoscopic extraction of a pancreatic stone encased in the minor papilla using dual-knife precut papillotomy technique allowing successful cannulation of the dorsal pancreatic duct. Videos are available only at the official website of the journal (www.eusjournal.com).

Acknowledgments

None.

Source of Funding

Dr Yan Chen is supported by the National Natural Science Foundation of China (No. 82200718).

Ethical Approval

This case was conducted in accordance with the ethical standards described in the latest revision of the Declaration of Helsinki.

Informed Consent

Informed consent for patient participation and publication was received from the patient.

Conflicts of interest

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Author Contributions

Yan Chen and Jie Chen did the concept and design. Yan Chen did the acquisition of data. Shi-Han Chen and Jia-Su Li performed the analysis and interpretation of data. Shi-Han Chen and Jia-Su Li wrote and reviewed the manuscript. Wei Zhu, Yan Chen, and Jie Chen reviewed the manuscript and performed study supervision.

Data Availability Statement

All data relevant to the case are included in the article.