• 31/F had come to us with recent episode of severe acute pancreatitis of unknown etiology
  • All conventional imaging, USG abdomen, CT Scan and MRI was inconclusive of etiology
  • EUS revealed multiple imaging microliths and small stones in the gall bladder and CBD. Pancreas appeared edematous with peripancreatic fat stranding in the body and tail region
  • Hence Endotherapy was performed and CBD was cleared off stones
  • In view of the severity of the acute pancreatitis a NJ tube was then placed across the DJ flexure under endoscopic and fluoroscopic control
  • NJ tube should allow enteral nutrition till the pancreatitis settles down

Take Home Message:

Patient with acute pancreatitis of unknown etiology should undergo EUS evaluation prior to any other imaging if all biochemistry is inconclusive of etiology.

EUS-ERCP Interface is the most reliable method for a certain diagnosis and optimum management for vast majority of Pancreato-Biliary diseases.

EUS also allows us to stratify the severity of pancreatitis and at the same time we can perform NJ tube placement for enteral nutrition as seen in this case.

EUS showed multiple imaging micoroliths and Small stones in the gall bladder and CBD

EUS showed multiple imaging micoroliths and Small stones in the gall bladder and CBD

Edematous pancreas with peripancreatic fat standing in the body and tail.

Edematous pancreas with peripancreatic fat standing in the body and tail.

 

 

 

 

 

 

 

 

 

 

Selective cannulation of CBD

Selective cannulation of CBD

Cholangiogram showed dilated CBD with small stones

Cholangiogram showed dilated CBD with small stones

 

 

 

 

 

 

 

 

 

 

Biliary sphincterotomy performed

Biliary sphincterotomy performed

A 7fr stent was placed in the CBD

A 7fr stent was placed in the CBD

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