Zusammenfassung
Bei Pankreatikolithiasis kann durch die ESWL eine partielle oder komplette Steinfreiheit
erreicht werden. Wir berichten über einen Patienten, bei dem es nach ESWL ohne vorherige
Sphinkterotomie zum Ductus Wirsungianus zu einer Inkarzeration eines Fragmentes im
distalen Pankreasgang kam. Dies unterstreicht die Empfehlung, vor ESWL von Pankreassteinen
eine Papillotomie zum Pankreasgang durchzuführen.
Incarceration of a pancreatic stone fragment in the distal pancreatic duct after ESWL-therapy
A partial or total absence of stones in pancreaticolithiasis therapy can be reached
by using ESWL. We report on a patient who happened to get an incarceration of a fragment
in the distal pancreatic duct after having been treated by ESWL without a previous
sphincterotomy to the ductus Wirsungianus. This emphasizes the recommendation to carry
out a papillotomy of the pancreatic main duct before applying ESWL to pancreatic stones.
Schlüsselwörter
Chronische Pankreatitis - Pankreatikolithiasis - ESWL - Ikterus
Key words
Chronic Pancreatitis - Pancreaticolithiasis - ESWL - Icterus
Literatur
1
Cremer M, Deviere J, Delhaye M, Vandermeeren A, Baize M.
Nonsurgical management of severe chronic pancreatitis.
Scand J Gastroenterol.
1990;
25 (suppl. 175)
77-84
2
Huibregste K, Schneider B, Vrij A A, Tytgat G NY.
Endoscopic pancreatic drainage in chronic pancreatitis.
Gastrointest Endosc.
1988;
34
9-15
3
Kozarek R A, Ball T J, Patterson D J. et al .
Endoscopic pancreatic duct sphincterotomy: Indications, technique, and analysis of
results.
Gastrointest Endosc.
1994;
40
592-598
4
Sauerbruch T, Holl J, Sackmann M, Paumgartner G.
Extracorporeal shock wave lithothripsy of pancreatic stones in patients with chronic
pancreatitis and pain: A prospective follow-up study.
Gut.
1992;
33
969-972
5
Costamagna G, Gabrielli A, Mutignani M. et al .
Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis:
Immediate and medium term results.
Gastrointest Endosc.
1997;
97
231-236
6
Booth F V, Doerr R J, Khalafi R S, Luchette F A, Flint L M.
Surgical management of complications of endoscopic sphincterotomy with precut papillotomy.
Am J Surg.
1990;
159
132-135 (discussion 135-136)
7
Adamek H E, Jakobs R, Buttmann A. et al .
Long-term follow-up of patients with chronic pancreatitis and pancreatic stones treated
with extracorporal shock wave lithotripsy.
Gut.
1999;
45
402-405
8
Johanns W, Jakobeit C, Deinert K, Greiner L.
ESWL-therapy in pancreatic duct calculi.
Leber Magen Darm.
1994;
24
210-213
9
Ohara H, Hoshino M, Hayakawa T. et al .
Single application extracorporeal shock wave lithotripsy is the first choice for patients
with pancreatic duct stones.
Am J Gastroenterol.
1996;
91
1388-1394
10
Ell C, Rabenstein T, Schneider H T. et al .
Safety and efficacy of pancreatic sphincterotomy in chronic pancreatitis.
Gastrointest Endosc.
1998;
48
244-249
11
Jakobs R, Benz C, Arnold C, Adamek H E, Riemann J F.
Safety and efficacy of pancreatic endoscopic sphincterotomy in chronic pancreatitis.
Gastroenterology.
1998;
(Suppl.) G4923
Anschrift für die Verfasser
Dr. med. Dieter Schilling
Medizinische Klinik C Klinikum der Stadt Ludwigshafen gGmbH
Bremserstraße 79
67063 Ludwigshafen
Email: MedCLu@t-online.de