A Case of Giant Pancreatic Stone With Pancreatic Duct Dilatation Associated With Pancreaticobiliary Maljunction

Abstract

Pancreaticobiliary maljunction (PBM) with pancreatic stones is relatively rare, and there is no established treatment for PBM with giant pancreatic stones. We report a case of PBM with giant pancreatic stones of 10 mm diameter or more with marked pancreatic duct dilation. The patient was a 12-year-old girl who had sudden abdominal pain three days prior to her hospital visit, and she was suspected of having acute pancreatitis by a previous physician. Abdominal ultrasonography and MRCP showed a giant pancreatic stone with dilation of the pancreatic duct in addition to PBM. The patient was diagnosed as having an acute pancreatitis-like attack due to incarceration of the pancreatic stone, and drainage of the pancreatic duct and bile duct was performed. As a result of an examination of the operation procedures, the pancreatic stone was to be removed endoscopically. Extrahepatic bile duct resection and hepaticojejunostomy were performed simultaneously with transpapillary endoscopic quarrying. The postoperative course was good and she was discharged 12 days after the operation. Transpapillary endoscopic quarrying may be effective in cases of PBM in children in whom intraoperative quarrying is difficult to perform owing to giant pancreatic stones.