Extracorporeal shock wave lithotripsy in the management of a 14-year-old girl with chronic calcific pancreatitis

Background. Chronic pancreatitis is very rare in childhood and causes chronic/relapsing abdominal pain, frequent hospitalizations, malnutrition, growth retardation, and stone formation in the main duct. Although pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is commonly used in the treatment of pancreatic stones (PS) in adults, the use in children is still controversial. An adolescent girl with multiple PS is presented to discuss the use of ESWL as a treatment alternative in children with PS. Case. A 14-year-old girl was admitted with abdominal pain and elevated pancreatic enzyme levels. Abdominal US showed irregularity and rough echogenicity in pancreas revealing pancreatitis. Multiple stones were seen in main pancreatic duct on Magnetic resonance cholangiopancreatography (MRCP). Endoscopic retrograde cholangiopancreatography (ERCP) was performed and dilated pancreatic duct, thickened pancreatic secretion were detected. Endoscopic sphincterotomy was performed. Endoscopic removal of stones could not be achieved since the largest stone was 17x8 mm. Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) was performed using electromagnetic lithotripter under general anesthesia. Following ESWL, fragmentation of stones in the main duct was confirmed with ERCP. After 3 sessions of ESWL, no ESWL-related complication was observed. Pain relief was achieved. The patient is still under follow-up regarding endocrine and exocrine function of pancreas. Conclusion. ESWL may be an effective and safe management option in pediatric PS which could not be removed by ERCP. The patients managed with ESWL should be followed-up for a long time regarding the endocrine and exocrine functions of the pancreas. As in management of adult pancreatitis, clinical guidelines are needed regarding the management of pediatric PS.

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1. Wang D, Bi YW, Ji JT, et al. Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis. Endoscopy 2017; 49: 447-455.

2. Haraldsson S, Roug S, Nojgaard C, et al. Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study. Scand J Gastroenterol 2018; 53: 1399-1403.

3. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980; 2: 1265-1268.

4. Sauerbruch T, Holl J, Sackmann M, Werner R, Wotzka R, Paumgartner G. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis. Endoscopy 1987; 19: 207-208.

5. Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline: Updated August 2018. Endoscopy 2019; 51: 179-193.

6. Moole H, Jaeger A, Bechtold ML, Forcione D, Taneja D, Puli SR. Success of extracorporeal shock wave lithotripsy in chronic calcific pancreatitis management: a meta-analysis and systematic review. Pancreas 2016; 45: 651-658.

7. Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stone with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas 2005; 30: 26-30.

8. Adamek HE, Jakobs R, Buttmann A, Adamek MU, Schneider AR, Riemann JF. Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gut 1999; 45: 402-405.
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
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