Gallstones Within the Pancreatic Duct: An Underlying Pancraticobiliary Maljunction

A 77-year-old woman presented with back pain of several years' duration. She did not consume alcohol, and had no family history of pancreatic disease. Her liver function tests were mildly elevated, but serum amylase and lipase were within normal limits. A subsequent magnetic resonance cholangiopancreatography (MRCP) showed choledocholithiasis without visible cholecystolithiasis, and pancreatolithiasis without any signs of chronic pancreatitis (Figure 1). Endoscopic cholangiopancraeatography (ERCP) with endoscopic removal of the stones reveales that the stones removed from the pancreatic duct also appeared to be gallstones (Figure 2 and Figure 3). Although there was no evidence of pancreaticobiliary maljunction (PBM) on the MRCP images, ERCP showed PBM with a small-caliber duct (Figure 4). Finally, the stones removed from the pancreatic duct were identified as calcium bilirubinate gallstones by composition analysis