Endoscopic sphincterotomy is a useful preoperative management for refractory pancreatitis associated with pancreaticobiliary maljunction.

Abstract

BACKGROUND:

Pancreatitis associated with pancreaticobiliary maljunction (PBM) is commonly treated nonoperatively before surgery. It is, however, sometimes uncontrollable, and little has been reported about the management.

METHODS:

Focusing on the preoperative management, we reviewed clinical courses of 4 PBM cases (ages 1 to 7 years old). Each had pancreatitis that was totally resistant to medical treatment and was applied endoscopic sphincterotomy (ES).

RESULTS:

The first case underwent percutaneous transhepatic catheter drainage (PTCD) primarily. In spite of daily lavage using the drainage tube for a week, plugs located in the common channel were not removed, and clinical findings were not improved. Therefore, ES followed by removal of protein plugs was performed to improve pancreatitis dramatically. Through this experience, 3 subsequent cases with refractory pancreatitis all underwent successful ES primarily soon after the medical treatments turned out to be ineffective. In all 4 cases, protein plugs were impacted in common channels, and ES could successfully remove the plugs that were impossible to remove by using PTCD. Improved preoperative pancreaticobiliary decompression by ES shortens the duration of recalcitrant acute pancreatitis associated with PBM allowing for a subsequent safe operation.

CONCLUSIONS:

Endoscopic sphincterotomy is one of the useful preoperative managements for refractory pancreatitis associated with PBM.

• Authors: Keita Terui, Hideo Yoshida, Katsunori Kouchi, Tomoro Hishiki, Takeshi Saito, Tetsuya Mitsunaga, Ayako Takenouchi, Toshio Tsuyuguchi, Taketo Yamaguchi, Naomi Ohnuma
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 43 Issue 3 Pg. 495-9 (Mar 2008) ISSN: 1531-5037 [Electronic] United States
• PMID: 18358288 (Publication Type: Journal Article)

Topics

• Child
• Child, Preschool
• Cholangiopancreatography, Endoscopic Retrograde
• Common Bile Duct (abnormalities)
• Female
• Follow-Up Studies
• Humans
• Infant
• Male
• Pancreatic Ducts (abnormalities)
• Pancreatitis, Chronic (diagnostic imaging, surgery)
• Preoperative Care (methods)
• Risk Assessment
• Sampling Studies
• Sphincter of Oddi (abnormalities, surgery)
• Sphincterotomy, Endoscopic (methods)
• Treatment Outcome