An Unusual Complication in Attempted Non-Surgical Treatment of Pancreatic Bile Duct Stones

Abstract

This report describes a guidewire fracture during an attempt at endoscopic treatment of pancreatic duct calculi in a patient with chronic pancreatitis, multiple pancreatic duct stenoses and pancreatic duct stones. This patient underwent endoscopic sphincterotomy in order to perform pancreatic duct drainage prior to ESWL. After sphincterotomy, a guidewire was introduced into the main pancreatic duct, but was jammed by the calculi. Neither could the guidewire be removed nor a contrast medium catheter be pushed over it, thus making ESWL impossible. A stronger pull resulted in a fracture of the wire, and a 25 mm long part which could not be removed with a Dormia basket remained in the main pancreatic duct. A Whipple's procedure became necessary as definitive treatment for the pancreaticolithiasis in this patient.