Pancreatic stones

1. What are pancreatic stones?

• Pancreatic stones are a chronic condition of the pancreas characterized by the formation of multiple hard calcium stones within the pancreatic ducts, including the main pancreatic duct and smaller pancreatic ducts.
• Pancreatic stones can obstruct the pancreatic ducts, causing recurrent episodes of pancreatitis and potentially leading to pancreatic fibrosis and impaired pancreatic function, and may even cause pancreatic cancer.

2. What are the clinical manifestations of pancreatic stones?

• Patients with pancreatic stones commonly seek medical attention due to persistent dull pain in the upper abdomen above the umbilicus and a history of recurrent pancreatitis. Some patients may present with diabetes, jaundice, weight loss, steatorrhea…
• A small number of patients have no symptoms, and the condition is discovered incidentally during health screening with abdominal ultrasound, abdominal X-ray, or abdominal CT scan.

3. How are pancreatic stones diagnosed?

• Abdominal ultrasound is a simple imaging modality that can detect pancreatic stones. However, ultrasound may have limitations in cases of small stones or when the area being examined is obscured by gastric gas.
• Abdominal computed tomography or magnetic resonance imaging is commonly used to accurately diagnose pancreatic stones. Imaging helps assess the number and location of stones, the degree of dilation of the pancreatic and bile ducts, the extent of pancreatic parenchymal fibrosis, and signs of pancreatic cancer.

4. What are the complications of pancreatic stones?

Pancreatic stones commonly obstruct the pancreatic ducts, causing chronic pancreatitis, which may lead to pancreatic fibrosis and impaired pancreatic function (causing diabetes, etc.) and may even cause pancreatic cancer.

5. What are the treatment options for pancreatic stones?

• Pancreatic stones without symptoms or pancreatic duct obstruction:
• Patients with very small pancreatic stones located within the pancreatic parenchyma that have not caused obstruction or dilation of the main pancreatic duct are generally not indicated for surgery. Patients are usually treated medically and advised to modify their diet and lifestyle habits.
• Symptomatic pancreatic stones causing pancreatic duct obstruction, particularly significant dilation of the main pancreatic duct or bile duct:
• Patients with multiple large pancreatic stones causing obstruction of the pancreatic or bile ducts and significant dilation of these ducts are usually indicated for surgery.
• The surgical approach depends on the location and number of pancreatic stones and whether bile duct obstruction is present. The surgeon will select the appropriate surgical method. Common surgical procedures include:
  • Pancreatic duct opening and stone removal
  • Pancreaticojejunostomy

6. Admission and treatment process

- Before surgery (day of admission):

• The treating physician will take the patient's medical history, perform a physical examination, and order relevant laboratory and diagnostic tests.
• Blood tests: creatinine, GOT, GPT, total bilirubin, direct bilirubin, lipase or amylase, albumin, electrolytes, complete blood count, coagulation tests (PT, aPTT, fibrinogen), blood type, hepatitis B and C tests, CA 19-9…
• Chest X-ray
• Abdominal ultrasound
• Abdominal CT scan or abdominal MRI
• Pre-anesthesia, perioperative, and relevant specialist consultations (cardiology, endocrinology, respiratory medicine…)
• The anesthesiologist will explain issues related to anesthesia.
• Surgery will be scheduled.
• The treating physician will explain the disease, treatment method, risks of adverse events and surgical complications, and obtain the patient's consent for surgery.
• Nurses will provide instructions on diet and medications that need to be discontinued, if any.
• The physician will mark the surgical site.

- Day of surgery:

• Usually on the second day after admission if there are no medical conditions requiring adjustment.
• The patient will be transferred to the operating room area (2nd floor) when an operating room is available.
• Change into surgical attire.
• Enter the operating room.
• Anesthesia
• Surgery
• Transfer to the recovery room.
• Care in the recovery room: approximately 12–24 hours.
• Transfer to the surgical department once the condition is stable.

- After surgery:

• The patient will be monitored daily to detect and treat potential complications, including bleeding and anastomotic leakage.
• Diet: On the first day after surgery, the patient may drink water, sugar water, and bird's nest beverage. From the second day, the patient may begin consuming liquid foods such as soup, rice water, and broth. If the condition remains stable, porridge may be started from the third day.
• Patients are encouraged to walk and practice breathing exercises frequently, which may begin immediately after being transferred from the operating room to the ward.
• Drainage tubes: usually removed 4–7 days after surgery.

- Discharge

• Patients are usually discharged 6–8 days after surgery.
• Surgical sutures are removed 10–14 days after surgery.
• Patients can resume a normal diet at home.
• Symptoms such as steatorrhea and frequent bowel movements may persist for several weeks. After a drainage tube is removed, it leaves an opening in the abdominal wall, which may continue to leak fluid for a similar period and usually heals spontaneously.

- Postoperative follow-up

• The patient will have the first postoperative follow-up at the Hepatobiliary and Gastroenterology Clinic 2–4 weeks after surgery.
• If the condition is stable, follow-up visits will be scheduled every 3–6 months.

- When should you call your doctor?

• Persistent high fever above 39°C
• Severe abdominal pain
• Nausea and vomiting
• Abdominal distension
• Bleeding
• Chills
• Persistent cough or difficulty breathing
• Chills
• Swelling, redness, or pus from the surgical wound
• Inability to eat or drink
• Any questions or concerns related to your recovery

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.