H. Abe et al., Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi, INT J UROL, 7(2), 2000, pp. 65-68
An elderly woman with a history of cholecystectomy and a re-operation for p
ostoperative peritonitis underwent extracorporeal shock wave lithotripsy (E
SWL) for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size,
to which 2400 and 1400 shots at 20 kV were given, respectively, on the sam
e day. During the evening after the operation, the patient started to compl
ain of upper abdominal pain. Laboratory examination on the next day reveale
d elevations in blood and urine amylase levels and a diagnosis of pancreati
tis was made. Conservative treatment, including administration of protease
inhibitor, did not improve her symptoms; abdominal distension became marked
and she underwent laparotomy. Necrosection and indwelling of several drain
tubes in abdomen were performed with an operative diagnosis of acute necro
tic pancreatitis. With daily irrigation of drain tubes and treatment for me
thicillin-resistant Staphyloococcus aureus the lungs and abdominal cavity,
septicemia and duodenal fistula, the patient gradually recovered and was di
scharged on postoperative day 151. It was suggested that ESWL was responsib
le for the acute pancreatitis. Either an obstruction of the pancreatic duct
by fragments of common duct stone, or mechanical injury of the pancreas du
e to adhesion between the pancreas and surrounding tissue caused by the lap
alotomy, was considered as a possible cause of pancreatitis. To our knowled
ge, there has been no previous report of severe acute pancreatitis and the
present case suggests that ESWL may cause severe pancreatic even in cases w
ithout stone shadow in the bile, common duct or pancreatic duct.