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CASE REPORT
The patient is a 42-year-old white male with recurrent episodes of acute pancreatitis in May 1999 and March 2004. Details from the first evaluation were not available. [Size=4]The March 2004 episode was preceded by the consumption of 4 beers [/size]and characterized by typical abdominal pain, elevated pancreatic enzymes (amylase 3,859 U/L, reference range: 30-110 U/L; lipase 6,511 U/L, reference range: 23-208 U/L) and abdominal CT consistent with non-necrotizing pancreatitis affecting the head of the pancreas. Right upper quadrant US was negative for cholelithiasis, choledocholithiasis or biliary ductal dilatation. ERCP at an outside hospital was not successful. The patient recovered completely with conservative therapy.
Following discharge the patient was referred to the Duke Biliary/Pancreatic Clinic for further evaluation of recurrent acute pancreatitis. His medical history was significant for a fractured leg secondary to playing football while in college though no known abdominal trauma was reported. He admitted to consuming 2-4 beers per week and smoked an occasional cigar but denied habitual or excessive consumption of alcohol or tobacco products. Family history was negative for cystic fibrosis, pancreatitis or pancreatic cancer. [Size=4]The patient had been using finasteride daily for the prior 3 years but no other medications[/size], over-the-counter products, herbs or supplements. Serum calcium and triglyceride levels were normal. EUS of the pancreas showed sonographic focal changes consistent with moderate-severe chronic pancreatitis in the pancreatic head extending up to the neck. There was no sign of significant endosonographic abnormality in the common bile duct or gallbladder. Pancreas divisum could not be assessed with this study; therefore, ERCP was performed at a subsequent date.
At ERCP, a complete pancreas divisum was identified (Figure 1). The dorsal duct appeared normal with no dilatation or features of chronic pancreatitis. After dorsal pancreatic sphincterotomy, a 3 Fr, 8 cm pancreatic stent with a 3/4 external pigtail and no internal flanges was placed into the dorsal pancreatic duct. The patient was instructed to have a supine abdominal radiograph in one week to confirm spontaneous passage of the stent. Instead, the local referring physician performed esophagogastroduodenoscopy for stent retrieval and found no evidence of the stent within the duodenal lumen. At this point, abdominal radiography was performed demonstrating persistence of the pancreatic stent in the area correlating with the pancreas and possible proximal stent migration was entertained.
Chronic pancreatitis
Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption
Symptoms
Patients with chronic pancreatitis usually present with persistent abdominal pain or steatorrhea resulting from malabsorption of the fats in food (typically very bad-smelling and equally hard on the patient), as well as severe nausea. Diabetes is a common complication due to the chronic pancreatic damage and may require treatment with insulin. Some patients with chronic pancreatitis look very sick, while others don’t appear to be unhealthy at all.
Considerable weight loss, due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein. Some chronic pancreatitis patients do not experience pain while others suffer from constant, debilitating pain. Weight loss can also be attributed to a reduction in food intake in patients with severe abdominal pain.
en.wikipedia.org/wiki/Chronic_pancreatitis
