• 06/M child came with a severe pain in abdomen for the last few days
  • EUS revealed a dilated fusiform intra pancreatic portion of the CBD and MPD with large soft stones leading to dilated CBD and MPD with changes of chronic pancreatitis.
  • ERCP was considered – Selective cannulation of MPD was achieved and pancreatogram confirmed EUS findings
  • All the soft stones were cleared from the MPD and a 5 fr single pigtail stent was placed into the MPD
  • In view of abnormal LFT a 7 fr stent was then placed in the CBD, patient’s symptoms subsided immediately after the procedure

Take Home Message:

Irrespective of the age of the patient even in children, EUS-ERCP interface allowed us to provide accurate diagnosis and optimum immediate treatment. Patient will require a definitive surgical intervention once Cholangitis and Pancreatitis subsides.

 

EUS showing dilated MPD with large soft stones

EUS showing dilated MPD with large soft stones

Selective cannulation of MPD was achieved

Selective cannulation of MPD was achieved

 

 

 

 

 

 

 

 

 

Pancreatogram showed fusiform dilatation with soft stones

Pancreatogram showed fusiform dilatation with soft stones

All the soft stones were cleared from the MPD

All the soft stones were cleared from the MPD

 

 

 

 

 

 

 

 

 

cholangiogram showed ductal anomaly

cholangiogram showed ductal anomaly

5fr single pigtail stent placed in the MPD and 7fr stent was placed in the CBD

5fr single pigtail stent placed in the MPD and 7fr stent was placed in the CBD

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