A case of gallstone pancreatitis due to cholesterol stones in which magnetic resonance cholangiopancreatography was useful

Abstract

A 59-year-old man with no medical history presented at our hospital with persistent orbital pain since the previous day. Blood tests revealed elevated hepatobiliary and pancreatic enzymes. Computed tomography (CT) showed no bile duct stones, only elevated peripancreatic lipid concentrations. Magnetic resonance cholangiopancreatography (MRCP) revealed a 3.5 mm defect in the lower bile duct and the patient was diagnosed as having acute cholangitis and gallstone pancreatitis. Emergency endoscopic retrograde cholangiopancreatography (ERCP) was performed to confirm the bile duct stones, and implant a 7 Fr × 7 cm plastic stent. The patient was discharged on post-operative day 12. Two months later, the patient underwent stone removal; the retrieved stones were found to be mainly composed of cholesterol. When acute cholangitis or gallstone pancreatitis is suspected and urgent ERCP is necessary, it is important to perform MRCP if the stones cannot be confirmed using CT.