Pancreatic stone: (pancreatolithiasis)

Pancreatic duct stones usually develop from cholesterol or bile salts and can block the flow of digestive enzymes from the pancreas to the small intestine. It is invariably associated with chronic pancreatitis and ductal stricture. The calculi form in the major and minor (second generation) pancreatic ducts. Commonly associated with diabetes (>85%) and malnutrition(>73%) and steatorrhea ( about 12%).  Pancreatolithiasis associated with pancreatic cancer in 3% to7% , in high endemic areas it is approximately 28%.

When the stones block the pancreatic duct, which connects the pancreas with the small intestine, the pancreas loses its ability to release digestive enzymes; the secretion of hormones that regulate blood sugar levels can also be affected.

 

 

Stone(s)in the pancreas is one of the common pancreatic diseases which need surgical intervention

In addition to the stones that form in the pancreas, stones that form in the gallbladder (gallstones) may become lodged in the common bile duct, which merges with the pancreatic duct. If either type of stone blocks the pancreatic duct pancreatic enzymes can back up inside of the pancreas, resulting in inflammation and pancreatitis.

Causes – Pancreatic duct stones often result from pancreatitis associated with alcohol abuse, hyperparathyroidism or Islet cell tumors.

Symptoms – Pancreatic duct stones often occur during episodes of pancreatitis. The signs and symptoms of acute pancreatitis may vary by person but is most commonly characterized by:abdominal pain that is felt in the upper left side or the middle of the abdomen. The pain may be worse after drinking or eating (especially foods that have a high fat content) or when lying on  back, and may radiate to the back or below the left shoulder blade. Other symptoms are , vomiting , jaundice,& clay-colored stools.

Diagnosed by abdominal x-ray, abdominal ultrasound ,Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS)

CT scan is of great value in determining characteristics and locations of pancreatolithiasis associated with pancreatic cancer

Treatment – Effective treatment is Pancreatolithotomy (removal of stone(s)) , in addition side-to-side pancreaticojejunostomy (anastmosis between pancreatic duct and small bowel) is the best choice for the treatment of pancreatolithiasis. Biopsy of pancreas is mandatory to exclude the possibility of associated pancreatic cancer. Pancreatic stone with extensive pancreatic fibrosis or damage may need resection in the form Whipple’s procedure or distal pancreatectomy. For patients with pancreatolithiasis associated with pancreatic cancer, surgical treatment should follow the principles of individualized therapy.

 

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