Combining pneumatic ballistic lithotripsy with an ultrasonic lithotripsy system in pancreatic duct stone surgery: A case report with video.

RATIONALE

Chronic pancreatitis can lead to the development of pancreatic stones. These stones may cause obstruction of the pancreatic duct, resulting in elevated intraductal pressure and abdominal pain. Surgery is an effective treatment for pancreatic stones. However, the removal of large pancreatic duct stones often presents significant technical challenges.

PATIENT CONCERNS

An 18-year-old female patient was admitted due to upper abdominal pain and recurrent vomiting over a 3-month period.

DIAGNOSES

Abdominal computed tomography showed multiple stones throughout the pancreatic duct and an exceptionally large stone (20 mm diameter) incarcerated in the main pancreatic duct.

INTERVENTIONS

The pancreatic duct was incarcerated within the main pancreatic duct and could not be removed. EMS lithotripsy was used to fragment and aspirate the stones.

OUTCOMES

Intraoperative exploration confirmed the absence of visible stone residues. The patient remained pain-free during the one-year postoperative follow-up.

LESSONS

EMS lithotripsy may serve as an effective alternative for patients with multiple pancreatic duct stones who are not candidates for endoscopic treatment and for whom the removal of impacted stones during surgery proves challenging.