Shetty Anurag J, Pai C Ganesh, Shetty Shiran, Balaraju Girisha
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal University, Manipal, 576 104, Karnataka, India.
Dig Dis Sci. 2015 Sep;60(9):2840-3. doi: 10.1007/s10620-015-3670-4. Epub 2015 May 6.
Biliary obstruction in chronic calcific pancreatitis (CCP) is often caused by inflammatory or fibrotic strictures of the bile duct, carcinoma of head of pancreas or less commonly by compression from pseudocysts. Pancreatic calculi causing ampullary obstruction and leading to obstructive jaundice is extremely rare.
The medical records of all patients with CCP or biliary obstruction who underwent endoscopic retrograde cholangiopancreatography (ERCP) over 4 years between 2010-2014 at Kasturba Medical College, Manipal were analyzed.
Five patients of CCP with impacted pancreatic calculi at the ampulla demonstrated during ERCP were identified. All 5 presented with biliary obstruction and were incidentally detected to have CCP when evaluated for the same; 3 patients had features of cholangitis. All the patients were managed successfully by endoscopic papillotomy and extraction of pancreatic calculi from the ampulla with resolution of biliary obstruction.
Pancreatic calculus causing ampullary obstruction, though very rare, should be considered as a possibility in patients with CCP complicated by biliary obstruction. Endoscopic therapy is affective in the resolution of biliary obstruction in such patients.
慢性钙化性胰腺炎（CCP）中的胆管梗阻通常由胆管的炎性或纤维化狭窄、胰头癌引起，较少见的原因是假性囊肿压迫。胰腺结石导致壶腹梗阻并引发梗阻性黄疸极为罕见。
分析了2010年至2014年期间在马尼帕尔卡斯图尔巴医学院接受内镜逆行胰胆管造影（ERCP）的所有CCP或胆管梗阻患者的病历。
在ERCP期间发现5例CCP患者壶腹部有嵌顿性胰腺结石。所有5例均表现为胆管梗阻，在因胆管梗阻接受评估时偶然发现患有CCP；3例有胆管炎特征。所有患者均通过内镜乳头切开术成功治疗，并从壶腹部取出胰腺结石，胆管梗阻得以缓解。
导致壶腹梗阻的胰腺结石虽然非常罕见，但在合并胆管梗阻的CCP患者中应考虑这种可能性。内镜治疗对这类患者胆管梗阻的缓解有效。
