Pancreatic Stones

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What Are Pancreatic Stones?

Stones can form in the main pancreatic duct or its smaller branch ducts. They are commonly associated with long-standing chronic pancreatitis, diabetes and poor nutrition.

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Causes of Pancreatic Stones

The exact cause is not always known. Possible contributing factors include:

  • Narrowing of the pancreatic duct (stricture pancreatic duct).
  • Hyperparathyroidism.
  • Diabetes. 85% of the cases of pancreatic stones are linked to diabetes.
  • Long-term alcohol use.
  • Smoking.
  • Islet-cell tumors.
  • Genetic and metabolic conditions.
  • Disorders affecting the immune system.

Symptoms of Pancreatic Stones

Possible symptoms include:

  • Repeated and sometimes severe abdominal pain.
  • Poorly controlled diabetes.
  • Fever.
  • Jaundice.
  • Indigestion.
  • Mucus-containing, fatty or greasy stools (steatorrhea).

Diagnosis of Pancreatic Stones

Tests may include:

  • Abdominal X-ray.
  • Abdominal ultrasound.
  • MRCP.
  • CT scan.
  • CA 19-9.
  • Endoscopic ultrasound.

Treatment of Pancreatic Stones

Treatment may include:

  • Removal of pancreatic stones (pancreatolithotomy).
  • Surgery to connect the pancreatic duct to the intestine to improve drainage (pancreatojejunostomy).
  • Pancreatic biopsy when cancer needs to be evaluated.
  • Removal of part of the pancreas when necessary (pancreatectomy):
    • Whipple's procedure.
    • Distal pancreatectomy.
    • Middle pancreatectomy.
  • Removal of stones through ERCP in selected cases.
  • Extracorporeal shock-wave lithotripsy (ESWL) in selected cases to remove the stones.

Complications of Pancreatic Stones

  • Chronic pancreatitis.
  • Pancreatic cancer in about 3–7% of cases. In high endemic areas the risk may rise up to 28%.
  • Reduced pancreatic function (pancreatic insufficiency).
  • Malnutrition in about 73% of cases.
  • Poor digestion.
  • Pancreatic steatorrhea (mucous/fatty stools) in 12% of cases.
  • Poorly controlled diabetes in 85% of cases.

Prevention of Pancreatic Stones

There is no guaranteed way to prevent all pancreatic stones. However, risk may be reduced by:

  • Keeping diabetes under control.
  • Treating hyperparathyroidism.
  • Avoiding smoking.
  • Avoiding alcohol.
  • Maintaining a balanced diet and adequate nutrition.

Conclusion

  • Pancreatic stones can occur together with chronic pancreatitis and may sometimes be associated with pancreatic cancer.
  • Appropriate evaluation and timely treatment are important.