case_images: PMC9891844_01
case_images: Imaging findings at initial examination. a Contrast CT shows no apparent pancreatic abnormality. b Endoscopic ultrasound shows both hyperechoic foci with posterior acoustic shadow and a honeycomb pattern of lobularity, which are considered EUS findings of chronic pancreatitis by the Rosemont classification. c Magnetic resonance cholangiopancreatography shows narrowing of the pancreatic duct in two locations. d Endoscopic retrograde cholangiopancreatography also shows irregular dilation of the main pancreatic duct and branch pancreatic ducts.
case_images: crg-2022-0017-0001-528768_f1.jpg
case_images: PMC9891844_01_crg-2022-0017-0001-528768_f1.jpg
case_images: F1
case_images: Computed tomography (CT) showed no obvious findings of chronic pancreatitis (shown in Fig. 1a). However, endoscopic ultrasound (EUS), which was performed to determine the etiology of the patient's pancreatitis, revealed both the hyperechoic foci with posterior acoustic shadow and the honeycomb pattern of lobularity, which are considered EUS findings of chronic pancreatitis by the Rosemont classification (shown in Fig. 1b). Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed that the pancreatic duct was narrowed in several locations (skip lesions), but no obstruction was found (shown in Fig. 1c, d).
case_images: Changes in CT findings over time. a One year later, CT also shows diffuse calcification of the pancreatic parenchyma. b Two years later, in addition to diffuse calcification, pancreatic duct dilatation became prominent. c Three years later, more calcification of the pancreas. Calcification is also seen within the main pancreatic duct, and duct dilatation has become stronger.
case_images: crg-2022-0017-0001-528768_f2.jpg
case_images: PMC9891844_01_crg-2022-0017-0001-528768_f2.jpg
case_images: F2
case_images: One year after his initial visit to our hospital, a pancreatic calcification developed in the pancreatic head (shown in Fig. 2a). Two years later, new dilatations in the main pancreatic duct were observed (shown in Fig. 2b). CT showed diffuse calcifications in the pancreas and further dilatation of the main pancreatic duct (shown in Fig. 2c).
case_images: Pancreatic duct stenting for a pancreatic duct stenosis in the pancreatic head. a The Wirsung duct is obstructed by a pancreatic stone. For this reason, stent placement through the Wirsung duct had to be abandoned. b The accessory papilla approach is used. c The pancreatic duct stent is placed from the accessory papilla to the main pancreatic duct. d The pancreatic duct dilation at the pancreatic tail is improved by pancreatic duct stenting.
case_images: crg-2022-0017-0001-528768_f3.jpg
case_images: PMC9891844_01_crg-2022-0017-0001-528768_f3.jpg
case_images: F3
case_images: Ultimately, drainage of the pancreatic body and tail was achieved through the accessory papilla (shown in Fig. 3a-c). No recurrence of acute or chronic pancreatitis has been reported for more than 6 months since the first pancreatic duct stent was placed (Fig. 3d).