27 Oct Inpatient admission: The patient’s admitting diagnosis was acute pancreatitis. Findings on a CT … . scan performed prior to admission were consistent with acute and chronic pancreatitis and pancreatic duct calculi.

Inpatient admission: The patient’s admitting diagnosis was acute pancreatitis. Findings on a CT … . scan performed prior to admission were consistent with acute and chronic pancreatitis and pancreatic duct calculi. Multiple stones were noted on endoscopic retrograde cholangiopancreatography (ERCP); one of them was big enough to occlude the pancreatic duct. There was generalized stenosis of the pancreatic duct. (During ERCP, a stent was put in place to bypass the area of obstruction. The patient improved immediately.) Extracorporeal shock wave lithotripsy (ESWL) then achieved partial fragmentation of the stone. Because of abdominal pain, a second ESWL was required and, again, achieved only partial fragmentation of the stone. The patient underwent another ERCP, which identified multiple stones and pancreatic duct stenosis with occlusion of the previously placed stent. During the procedure, the obstructed area was passed through, but there was still a 2-millimeter area of pancreatic duct stenosis. A balloon was inserted to dilate this area endoscopically. There were multiple stones, and the occluded stent was removed and replaced with a new one beyond the area of obstruction. No puncture of the skin or mucous membrane was necessary to remove or replace the occluded stent. Discharge diagnoses: (1) Acute and chronic pancreatitis, (2) pancreatic calculi. Procedures: (1) ERCP with pancreatic duct stent insertion, (2) ESWL (pancreatic stone) on two sep- arate occasions, (3) ERCP with prolonged dilation of pancreatic duct and removal of occluded stent and replacement with a new, single-pigtail stent.