A 38 yrs male patient was referred to evaluate the exact etiology of recurrent episodes of acute pancreatitis since last few years (> 5 episodes). So far all imaging studies have been inconclusive.

  • EUS revealed normal CBD and gall bladder.
  • MPD appeared dilated (4.5 mm) in the head region with prepapillary narrowing of the MPD and dilated side branches.
  • A small stone and few concrements were seen in the prepapillary portion of the MPD.
  • Abnormal course of MPD was noted in the head region which raises suspicion of incomplete divisum.
  • MPD appeared undilated and irregular in the genu and body. No evidence of any hypoechoic lesion in the pancreas. No evidence of any pseudocyst or nodes.
  • Selective cannulation of MPD
  • Pancreatogram showed ‘S’ shaped MPD with incomplete divium.
  • Major papilla sphincterotomy was performed after a 3 fr stent was placed through the major papilla and prepapillary stone was seen exuding out of Minor papilla which was delivered with minor papilla sphincterotomy

EUS revealed normal CBD and gall bladder

A small stone and few concrements were seen in the prepapillary portion of the MPD.

 

 

 

 

 

 

 

MPD appeared dilated and irregular in the genu and body.

Selective cannulation of MPD

 

 

 

 

 

 

 

 

Pancreatogram showed ‘S’ shaped MPD with incomplete divium.

A 3 fr stent was then placed and prepapillary stone seen exuding out of minor papilla

 

 

 

 

 

 

 

 

Minor papilla sphincterotomy

Major papilla sphincterotomy performed

A 52 yrs old male patient was referred to us for  the favour of EUS to evaluate the exact status of pancreas in view of recent episodes of acute pancreatitis. Patient has lost 5 kgs in the last few weeks and is complaining of recurrent pain off and on. All other imaging studies have been inconclusive so far.

  • EUS revealed a large hypoechoic mass lesion in the pancreatic head region ( 3.5 cms x 3.0 cms) with multiple large nodes.
  • The mass appeared hard on Elastography. Contrast enhanced EUS was then performed which revealed hypoenhancement in the lesion suggestive of neoplastic process.
  • A lesion was also noted in the left lobe of liver which measured around 11 mm x 14 mm.
  • In view of these findings EUS guided FNA was then performed first from the left lobe liver lesion under color doppler control with a 22 g needle.
  • This was followed by one pass into the primary mass in the pancreatic head region. Aspirated material was sent for cytological examination and cell block preparation.

A large hypoechoic mass lesion in the pancreatic head region

The mass appeared hard on Elastography

 

 

 

 

 

 

 

 

Contrast enhanced EUS was then performed

A lesion was also noted in the left lobe of liver

 

 

 

 

 

 

 

 

EUS guided FNA was then performed first from the left lobe liver lesion

EUS guided FNA was then performed from the pancreatic head region.