Rapid Radiological Disappearance of Pancreatic Duct Stones Following Oral Trimethadione

A 59-year-old man with chronic pancreatitis, surgically altered anatomy, and an implantable cardioverter-defibrillator presented with acute exacerbation caused by cast-like obstructive pancreatic duct stones. Endoscopic therapy was considered technically difficult, and extracorporeal shock wave lithotripsy was avoided. While delayed surgical drainage was being considered, off-label oral trimethadione was started after institutional ethics approval. Computed tomography 2 weeks later showed disappearance of the stones and improvement of ductal dilatation. No adverse events occurred, and surgery was deferred. This case suggests that trimethadione may be a potential salvage option when standard interventions are infeasible.