Mohammad Ishaq Shaikh, Zaman Shaikh, Nadeem Akhtar.
Idiopathic Chronic Pancreatitis: A Case Report.
J Coll Physicians Surg Pak Jan ;10(2):78-9.

An interesting case of chronic pancreatitis is reported. A middle-aged lady presented to us with the history of loose motions for last ten years and her plain abdominal X-ray showed calcification in upper abdomen This case illustrates the rare occurrence of idiopathic chronic pancreatitis.

CASE REPORT: A middle-aged housewife, resident of Karachi, presented with history of pain in the upper abdomen ten years back. The pain was moderate in intensity, gripping in nature, localized in the middle and unrelated to the posture. Couple of minutes later, patient felt the urge and passed the stool. Stool was brownish yellow in color, sticky and oily, difficult to flush but devoid of blood or mucus. Pain was relieved after passing the stool. Over the past few years, repeatedly experienced that about twenty minutes after taking meals, she used to develop pain in abdomen of similar character. Initially, she passed 3 to 4 stools per day, however, frequency of stools increased gradually and since last one year she was having 10-15 stools in twenty-four hours. Now, pain was of mild intensity. Gradually, she lost almost twelve kg of weight during the last few years. There was no history of similar illness in the family. On general examination, anemia and generalized wasting were evident. In respiratory system examination, breathing was normal, vesicular with no added sounds. Central nervous system, cardiovascular system and abdominal examinations were also unremarkable.

On investigations, Hb was 11gm% and peripheral blood film revealed normocytic normochromic picture. TLC and platelets were within normal limits. Urine D/R revealed the Random blood sugar on two different occasions was elevated (230 and 260 mg% respectively).X-ray chest was within normal limits.Plain abdominal X-ray revealed calcification at T12-L2 level, over the pancreatic area. Calcification was diffuse, involving the whole of pancreatic parenchyma. CT scan abdomen showed features of chronic pancreatitis, that is, fibrosis and 1 multiple areas of calcification in the parenchyma as well as in the ducts of pancreas. Main pancreatic duct was dilated.Barium studies were unremarkable and there was no evidence of secondary effects of chronic pancreatitis like distended duodenum. Barium studies were unremarkable and there was no evidence of secondary effects of chronic pancreatitis. Stool D/R was negative for any possibility of infective origin of diarrhoea. To document malabsorption, twenty-four hour collection of stool for fat was performed with necessary precautions. This turned out to be 6.5 gm, higher than the normal limits. To exclude the possibilities of small bowel origin of malabsorption, Xylose absorption test was carried out, which was within normal limits indicating normal small intestinal function. Exocrine function of pancreas was assessed by doing the serum amylase and serum lipase levels, which were normal. Serum calcium and parathormone levels were within normal limits. Serum total protein with A/G ratio and total lipid profile was also within normal limits.

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