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Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication
To cite this article: Adioui T, et al. Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication. Presse Med. (2016), http://dx.doi.org/10.1016/j.lpm.2016.11.027 Presse Med. 2016; //: ///
Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication Stripping de gaine de fil guide en intrapancréatique au cours d'un traitement endoscopique de pancréatite chronique : une complication rare
discharge of calcic fragments. At that moment, the guidewire was incrusted around calculi. Attempts to withdraw the guidewire caused stripping and fragmentation of distal floppy coating (figure 2). The patient presented no acute complication. We decided then to merely monitor the patient due to absence of symptoms, and surgery will be considered depending on the subsequent evolution. Guidewire fracture and retention into common bile duct is a known complication during endoscopic retrograde cholangiopancreatography. Proposed mechanisms are excessive traction, imperfections of the floppy coating with the risk of electrical short circuit and forceful rotations. Potential risks of guidewire retention include infection or abscess formation
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
A 31 year-old man with a history of recent diabetes was admitted for acute abdominal pain and vomiting. Laboratory tests showed elevated lipase and leukocytosis. On CT scan, pancreas was atrophic with dilated main pancreatic duct (MPD) and multiple parenchymal and intraductal calcifications. After etiological investigation, the diagnosis of idiopathic chronic pancreatitis was retained. Endoscopic retrograde cholangiopancreatography revealed irregular and dilated MPD with multiple filling defects (figure 1). Using a Boston scientific 0,035'' Endoglide coated straight tip Jagwire and a triple lumen sphincterotome, pancreatic sphincterotomy was performed allowing spontaneous
Figure 1
Figure 2
Cholangiopancreatography showing irregular and dilated MPD. Note the stripping of the tip and fracture of the floppy coat (arrow)
A: plain abdominal radiograph showing fragmented floppy coat around a pancreatic calculus. B: after withdrawal, the guidewire was sheared with visible tungsten fill
1
tome xx > n8x > xx 2016
LPM-3255
To cite this article: Adioui T, et al. Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication. Presse Med. (2016), http://dx.doi.org/10.1016/j.lpm.2016.11.027
Letter to the editor
T. Adioui, M. Tamzaourte, Y. Touibi, F. Rouibaa, A. Aourarh
due to foreign body reaction and impedance to drainage. However, guidewire fracture into main pancreatic duct is exceptional and only three cases have been reported. The fractured guidewire was remained in situ in one patient with no complications and a Whipple's procedure was necessary in the others patients both to remove guidewire fragment and pancreatico-lithiasis [1,2]. Acknowledgements: authors do not want to configure any acknowledgments and disclose no financial relationships relevant to this publication. Authors' contribution: Aziz Aourarh and Fedoua Rouibaa realized ERCP. Tarik Adioui, Youssef Touibi and Mouna Tamzaourte evaluated the patient and wrote the manuscript.
2
Disclosure of interest: the authors declare that they have no competing interest.
References [1] [2]
Pruitt A, Schutz SM, Baron T, McClendon D, Lang KA. Fractured hydrophilic guidewire during ERCP: a case series. Gastrointest Endosc 1998;48(1):77–80. Heinerman M, Mann R, Boeckl O. An unusual complication in attempted nonsurgical treatment of pancreatic bile duct stones. Endoscopy 1993;25:248–50. Tarik Adioui, Mouna Tamzaourte, Youssef Touibi, Fedoua Rouibaa, Aziz Aourarh Gastroenterology I unit, Mohamed V military teaching hospital, Mohamed V-Souissi University, Hay Riyad, 10100 Rabat, Morocco Correspondence: Tarik Adioui, Mohamed V military teaching hospital, Gastroenterology I unit, Mohamed V-Souissi University, Hay Riyad, 10100 Rabat, Morocco [email protected] Received 3 August 2016 Accepted 21 November 2016 Available online:
http://dx.doi.org/10.1016/j.lpm.2016.11.027 © 2016 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2016
Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication Stripping de gaine de fil guide en intrapancréatique au cours d'un traitement endoscopique de pancréatite chronique : une complication rare
discharge of calcic fragments. At that moment, the guidewire was incrusted around calculi. Attempts to withdraw the guidewire caused stripping and fragmentation of distal floppy coating (figure 2). The patient presented no acute complication. We decided then to merely monitor the patient due to absence of symptoms, and surgery will be considered depending on the subsequent evolution. Guidewire fracture and retention into common bile duct is a known complication during endoscopic retrograde cholangiopancreatography. Proposed mechanisms are excessive traction, imperfections of the floppy coating with the risk of electrical short circuit and forceful rotations. Potential risks of guidewire retention include infection or abscess formation
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
A 31 year-old man with a history of recent diabetes was admitted for acute abdominal pain and vomiting. Laboratory tests showed elevated lipase and leukocytosis. On CT scan, pancreas was atrophic with dilated main pancreatic duct (MPD) and multiple parenchymal and intraductal calcifications. After etiological investigation, the diagnosis of idiopathic chronic pancreatitis was retained. Endoscopic retrograde cholangiopancreatography revealed irregular and dilated MPD with multiple filling defects (figure 1). Using a Boston scientific 0,035'' Endoglide coated straight tip Jagwire and a triple lumen sphincterotome, pancreatic sphincterotomy was performed allowing spontaneous
Figure 1
Figure 2
Cholangiopancreatography showing irregular and dilated MPD. Note the stripping of the tip and fracture of the floppy coat (arrow)
A: plain abdominal radiograph showing fragmented floppy coat around a pancreatic calculus. B: after withdrawal, the guidewire was sheared with visible tungsten fill
1
tome xx > n8x > xx 2016
LPM-3255
To cite this article: Adioui T, et al. Intrapancreatic guidewire outer coat stripping during endoscopic treatment of chronic pancreatitis: A rare complication. Presse Med. (2016), http://dx.doi.org/10.1016/j.lpm.2016.11.027
Letter to the editor
T. Adioui, M. Tamzaourte, Y. Touibi, F. Rouibaa, A. Aourarh
due to foreign body reaction and impedance to drainage. However, guidewire fracture into main pancreatic duct is exceptional and only three cases have been reported. The fractured guidewire was remained in situ in one patient with no complications and a Whipple's procedure was necessary in the others patients both to remove guidewire fragment and pancreatico-lithiasis [1,2]. Acknowledgements: authors do not want to configure any acknowledgments and disclose no financial relationships relevant to this publication. Authors' contribution: Aziz Aourarh and Fedoua Rouibaa realized ERCP. Tarik Adioui, Youssef Touibi and Mouna Tamzaourte evaluated the patient and wrote the manuscript.
2
Disclosure of interest: the authors declare that they have no competing interest.
References [1] [2]
Pruitt A, Schutz SM, Baron T, McClendon D, Lang KA. Fractured hydrophilic guidewire during ERCP: a case series. Gastrointest Endosc 1998;48(1):77–80. Heinerman M, Mann R, Boeckl O. An unusual complication in attempted nonsurgical treatment of pancreatic bile duct stones. Endoscopy 1993;25:248–50. Tarik Adioui, Mouna Tamzaourte, Youssef Touibi, Fedoua Rouibaa, Aziz Aourarh Gastroenterology I unit, Mohamed V military teaching hospital, Mohamed V-Souissi University, Hay Riyad, 10100 Rabat, Morocco Correspondence: Tarik Adioui, Mohamed V military teaching hospital, Gastroenterology I unit, Mohamed V-Souissi University, Hay Riyad, 10100 Rabat, Morocco [email protected] Received 3 August 2016 Accepted 21 November 2016 Available online:
http://dx.doi.org/10.1016/j.lpm.2016.11.027 © 2016 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2016