A CASE OF PANCRATIC STONES IN THE RESIDUAL BILE DUCT COMPLICATING WITH PANCREATODUODENAL FISTULA

Abstract

A 65-year-old man was admitted to our hospital because of chronic pancreatitis withpancreatic stones. He received hepatico-jejunostomy and pancreatojejunostomy 16 years ago.ERCY showed a fistula on the posterior side of the major papilla from the main pancreatic duct(MPD)and abnornlal pancreatico biliary union. The bile and pancreatic ducts in the majorpapilla were extremely marrow. The stones were observed in the residual bile duct and MPD.These stones were treated by extracorpo shockwave/ithotripsy(ESWL)and endoscopicsphyncterotomy. These stones were composed of 93%calcium bicarbonate. A plastic stent wasplaced through the fistula for drainage of MPD. After drainage he has been asymptomatic andthe urinary C-peptide titer increased 3 months later.