Horwhat John David, Jowell Paul, Branch Stanley, Fleishman Leonie, Gress Frank G
Division of Gastroenterology, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.
JOP. 2005 Mar 10;6(2):178-84.
Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis following sphincterotomy of the minor papilla in patients with recurrent acute pancreatitis and pancreas divisum. Increasingly, endoscopists that perform pancreatic ERCP are placing small caliber (3 Fr), unflanged, single pigtail stents into the long axis of the pancreatic duct with the expectation that these stents will only stay in place for a few days and the majority will pass spontaneously on their own without the need for follow-up endoscopic retrieval. As such, these stents are generally regarded as safer and associated with a lower rare of complication than larger (5 and 7 Fr), double flanged pancreatic stents.
We present the case of a 3 Fr stent that migrated proximally into the dorsal duct in a patient with recurrent pancreatitis and pancreas divisum. Due to the small size of the patient's dorsal duct, it was difficult to pass appliances alongside the stent to facilitate retrieval and a variety of appliances were used before success was achieved.
The medical literature contains series of proximally migrated larger caliber flanged, pancreatic stents but proximal migration of small caliber, unflanged, pigtail stents has not yet been reported. As the use of these small stents increases, we feel that it is important to highlight the potential for this complication and discuss how we successfully treated our patient.
在治疗性内镜逆行胰胆管造影（ERCP）期间，可出于多种适应证放置胰管支架。其中一种适应证是预防复发性急性胰腺炎和胰腺分裂症患者在小乳头括约肌切开术后发生胰腺炎。越来越多进行胰管ERCP的内镜医师将小口径（3F）、无侧翼、单猪尾支架沿胰管长轴放置，期望这些支架仅留置几天，大多数会自行排出，无需后续内镜取出。因此，与较大尺寸（5F和7F）的双侧翼胰管支架相比，这些支架通常被认为更安全，并发症发生率更低。
我们报告一例复发性胰腺炎和胰腺分裂症患者，其3F支架向近端迁移至背侧胰管。由于患者背侧胰管管径小，难以在支架旁通过器械以利于取出，在成功取出前使用了多种器械。
医学文献中有关于较大口径侧翼胰管支架向近端迁移的系列报道，但小口径、无侧翼、猪尾支架向近端迁移尚未见报道。随着这些小支架的使用增加，我们认为强调这种并发症的可能性并讨论我们如何成功治疗该患者很重要。
