Stenting of the Pancreatic Duct in Acute Biliary Pancreatitis to Avoid Delayed Cholecystectomy (Clinical Case)

Introduction. Purpose of clinical observation is to show expediency of evaluating parameters of pancreatic perfusion in patients with acute biliary pancreatitis according to computed tomography on first day of disease and stenting of pancreatic duct with insertion of tip of stent beyond hypoperfusion zone after eliminating cause of impaired bile outflow from common bile duct.

Clinical observation. Patient was admitted 10 hours after appearance of complaints, ultrasound revealed calculous cholecystitis, signs of biliary hypertension, an increase in bilirubin, transaminases, and amylase activity (2115 U/l). CT showed hypoperfusion in neck of pancreas with fluid-infiltrative changes in retroperitoneal tissue. EPST, lithoextraction, and stenting of pancreatic duct were urgently performed. Then, there was decrease in level of bilirubin, transaminases, and amylase to reference values. Laparoscopic cholecystectomy was performed on 8 day. Course of postoperative period is without complications. He was discharged in satisfactory condition on 10th day of hospitalization. Stent was removed after 1 month.

Conclusion. CT data allowed not only to confirm diagnosis of choledocholithiasis with development of biliary hypertension, but also to obtain important information about hypoperfusion of parenchyma, mainly neck of pancreas, and formation of parapancreatitis already on 1st day of disease. Timely EPST performed with elimination of bile outflow block and stenting of pancreatic duct with a stent beyond hypoperfusion zone contributed to rapid relief of jaundice, cytolysis and acute pancreatitis with regression of local manifestations. This made it possible to perform cholecystectomy during the same hospitalization and prevented the likelihood of complications observed with delayed removal of gallbladder.

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