A 59-year-old man with alcohol-induced pancreatitis was referred due to dilated pancreatic
duct and pancreatic mass. He had presented 9 years earlier with gastrointestinal bleeding
secondary to hemosuccus pancreaticus, which was treated by interventional radiology-guided
coil and glue application to the superior pancreatico-duodenal artery pseudoaneurysm.
He had complained of postprandial upper abdominal pain and a 10-lb weight loss, and
had experienced recurrent acute pancreatitis in the preceding 4 months. Contrast-enhanced
computed tomography showed dilated pancreatic duct and multiple coils around the head
of the pancreas, and extensive shadowing artifact precluded further evaluation.
Endoscopic ultrasound revealed a dilated main pancreatic duct with intraductal filling
and a 25 × 16 mm hypoechoic lesion in the head of the pancreas near the coils ([Fig. 1]). Cytology showed epithelioid cells with abundant debris and no evidence of malignancy.
Fig. 1 Endoscopic ultrasound showed a dilated main pancreatic duct (red arrow) and intraductal
filling (white arrow).
Endoscopic retrograde cholangiopancreatography was performed. After biliary sphincterotomy,
the pancreatic orifice was cannulated with a 3.9-Fr sphincterotome and 0.025-inch
angled tip guidewire. A diffuse dilated pancreatic duct and large filling defect was
seen on pancreatogram ([Fig. 2]). Spyglass DS (Boston Scientific, Marlborough, Massachusetts, USA) was passed over
the guidewire and multiple large white stones were revealed ([Fig. 3]). The stones were fragmented using electrohydraulic lithotripsy. Multiple eroded
coils were also seen in the proximal duct, from prior embolization ([Fig. 4]). The coils were removed with SpyBite (Boston Scientific) and rat-tooth forceps
([Video 1]). Two 7 Fr × 12 cm single-pigtail plastic stents were deployed to maintain duct
patency.
Fig. 2 Endoscopic retrograde cholangiopancreatography showed coils (black arrow) and intraductal
filling (yellow arrow). There was also diffuse main pancreatic duct dilation.
Fig. 3 Pancreatic stones seen on SpyGlass examination (Boston Scientific, Marlborough, Massachusetts,
USA).
Fig. 4 SpyGlass examination (Boston Scientific, Marlborough, Massachusetts, USA) showed coils
(red arrow) eroded into the pancreatic duct.
Video 1 Diagnosis and management of chronic relapsing pancreatitis due to eroded embolization
coils.
The patient tolerated the procedure well and was seen 1 month later, with marked improvement
of symptoms and plan to follow up in 3 months.
Coils from prior embolization that have eroded into the gastrointestinal lumen and
then either passed spontaneously or been removed endoscopically have been reported
[1]
[2]. To our knowledge, this is the first report of effective endoscopic management of
recurrent pancreatitis caused by coils and glue expelled into the pancreatic duct.
Endoscopy_UCTN_Code_TTT_1AR_2AK
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