Acute Pancreatitis Induced by Migration of Bile Duct Stone into the Main Pancreatic Duct—A Case Report—

Abstract

Acute gallstone pancreatitis occurs when a gallstone is impacted into the duodenal papilla and occludes both the main pancreatic duct (MPD) and the bile duct. However, migration of the gallstone from the bile duct into the MPD is a rare situation. Here, we report a case where the bile duct stone migrated into the MPD and thereby induced acute gallstone pancreatitis. A 61-year-old man was admitted to our hospital with a complaint of epigastric pain. He was diagnosed with choledocholithiasis, and endoscopic lithotomy was planned. After 4 days, epigastric pain reappeared, and the patient was urgently hospitalized with a diagnosis of acute gallstone pancreatitis. Abdominal CT scan showed suspected migration of a bile duct stone into the MPD. Emergency endoscopic retrograde cholangiopancreatography was performed, which showed no filling defect in the common bile duct, while a filling defect was seen in the MPD, consistent with migration of a bile duct stone. Temporary pancreatic stent placement was performed, and acute pancreatitis symptoms improved. Finally, endoscopic lithotomy was successfully performed following laparoscopic cholecystectomy. Spontaneous migration of a gallstone into the MPD is extremely rare and has not previously been reported. However, we should keep it in mind as a cause of acute gallstone pancreatitis.