Pancreatography by direct puncture of the pancreatic duct guided by real-time ultrasound was used preoperatively to evaluate three cases of chronic pancreatitis. Our experience of this technique went as anticipated without any complications. The association of ultrasonography, ultrasonically guided pancreatography, and aspiration biopsy is proposed as an approach to the diagnosis of pancreatic disease.
CASE REPORTS
Case 1 A 28-year-old heavy consumer of alcohol was referred for a n ultrasonic examination because of epigastric pain. Ultrasonic findings revealed an enlargement of the pancreatic duct (4-5 mm), a small cystic lesion (20 mm) on the midportion of the pancreas, and echogenic spots with acoustic shadows in the pancreatic head (Fig. 1). This last finding corresponded to calcifications on the abdominal plain film. The echopattern of the pancreas was irregular and the diagnosis of chronic pancreatitis was suspected. Traditional medical care had been unsuccesshl in alleviating the pain. The retrograde endoscopic pancreatography could not be performed due to an obstacle a t the level of the proximal Wirsung's duct. Percutaneous pancreatography under ultrasonic guidance revealed severe atrophic pancreatitis with calculi in the pancreatic duct (Fig. 2). During the laparotomy no site of puncture had been discovered. A pan-From the Service de Radiologie-Pavillon Chirurgical A,