RADIOLUCENT PANCREATIC CALCULI TREATED BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY, PANCREATOGRAPHY, AND ENDOSCOPIC NASOPANCREATIC DRAINAGE : CASE REPORT

Abstract

The patient was a 38 year-old man. He had no history of drinking, but presented with epigastralgia after meals for 2 years. Abdominal CT showed atrophy of the whole pancreas and dilatation of the main pancreatic duct. Since endoscopic retrograde cholangiopancreatography (ERCP) showed several filling defects in the main pancreatic duct and its side branch, he was diagnosed as having radiolucent pancreatic calculi. Entracorporeal shock wave lithotripsy (ESWL) was performed 8 times under monitoring by pancreatography, while the patient was on endoscopic nasopancreatic drainage (ENPD). This treatment noninvasively eliminated the pancreatic calculi and resolved his abdominal pain. The combination of ENPD with ESWL was useful for the following reasons : (1) assistance with focusing, (2) drainage of the fragmented pancreatic calculi, (3) assessment of therapeutic effect, and (4) examination of the pancreatic juice.