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Jain Y, Gattani RG, Shinde RK, Deshpande SG. Early Diagnosis and Surgical Management of Tropical Chronic Pancreatitis in a Tertiary Care Rural Hospital: A Case Report. Cureus 2023; 15:e49826. [PMID: 38169720 PMCID: PMC10758541 DOI: 10.7759/cureus.49826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
Tropical chronic pancreatitis represents a variant of chronic calcific non-alcoholic pancreatitis, typically found in adolescents and young adults, predominantly in developing nations. This condition usually presents as a classic triad of recurrent and severe abdominal pain, diabetes, and steatorrhea. As the disease progresses and diabetes develops, it is called fibrocalculous pancreatic diabetes. A defining characteristic of this ailment is the presence of pancreatic calculi, leading to duct dilation. Key features of this condition include an early onset in youth, intraductal calculi, an aggressive disease course, and a heightened susceptibility to pancreatic cancer. Diagnostic tools such as ultrasound, CT, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography aid in identifying the disease. Timely diagnosis and treatment significantly reduce mortality and morbidity. Our patient, a young female, presented solely with recurrent episodes of abdominal pain resembling pancreatitis, along with a normal biological profile and an absence of readily apparent symptoms. She received a diagnosis of tropical chronic pancreatitis and underwent the Partington-Rochelle procedure for surgical decompression of the main pancreatic duct.
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Affiliation(s)
- Yashraj Jain
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajesh G Gattani
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swati G Deshpande
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Maatman TK, Zyromski NJ. In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2020.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maatman TK, Zyromski NJ. Chronic Pancreatitis. Curr Probl Surg 2020; 58:100858. [PMID: 33663691 DOI: 10.1016/j.cpsurg.2020.100858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Thomas K Maatman
- Resident in General Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicholas J Zyromski
- Professor of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA..
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Chowdhury SD, Chacko A, Ramakrishna BS, Dutta AK, Augustine J, Koshy AK, Simon EG, Joseph AJ. Clinical profile and outcome of chronic pancreatitis in children. Indian Pediatr 2013; 50:1016-9. [PMID: 23798627 DOI: 10.1007/s13312-013-0281-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/03/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children. DESIGN Retrospective chart review. SETTING Gastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010. PARTICIPANTS 99 Children (>18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features. MAIN OUTCOME MEASURES Etiology, clinical presentation, complications and management of chronic pancreatitis in children. RESULTS Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27%) had pain relief. There was no death. CONCLUSIONS Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.
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Affiliation(s)
- S D Chowdhury
- Department of GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Professor Ashok Chacko, Department of G.I. Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
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Bai HX, Giefer M, Patel M, Orabi AI, Husain SZ. The association of primary hyperparathyroidism with pancreatitis. J Clin Gastroenterol 2012; 46:656-61. [PMID: 22874807 PMCID: PMC4428665 DOI: 10.1097/mcg.0b013e31825c446c] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The association between primary hyperparathyroidism (PHPT) and acute or chronic pancreatitis is controversial. For this reason, we conducted a review of the literature over the past 30 years to explore the relationship between these 2 disorders. Ten retrospective studies each with >50 patients diagnosed with PHPT were identified. With the notable exception of 2 studies, the rate of pancreatitis among patients with PHPT was higher than that reported in general among hospitalized patients without PHPT. A higher serum calcium level may contribute to pancreatitis in these cases, along with additional genetic or environmental insults. Hypercalcemia may predispose the pancreatic acinar cell to abnormal, sustained calcium levels, lead to premature pancreatic protease activation, and pancreatitis. Although there was only short-term follow-up, most reports cited that definitive treatment of PHPT by parathyroidectomy led to the resolution of pancreatitis attacks. The published cohorts of patients with PHPT and pancreatitis are subject to bias, because serum calcium screening was not universally performed among all control nonpancreatitis patients to evaluate for PHPT. However, the pooled clinical and experimental data suggest an association between PHPT and pancreatitis and implicate hypercalcemia. For clinicians, it is important to recognize pancreatitis in patients with PHPT and, conversely, to consider PHPT by checking serum calcium levels in patients, who present with an unexplained pancreatitis.
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Affiliation(s)
- Harrison X. Bai
- Departments of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Mohini Patel
- Departments of Pediatrics, Yale University School of Medicine, New Haven, CT
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Reddy DN, Ramchandani MJ, Talukdar R. Individualizing therapy for chronic pancreatitis. Clin Gastroenterol Hepatol 2012; 10:803-4. [PMID: 22504003 DOI: 10.1016/j.cgh.2012.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 02/07/2023]
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Ashish K, Vivek V, Adnan S. Recurrent Abdominal Pain in a Young Adult. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n6p277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Farris AB, Basturk O, Adsay NV. Pancreatitis, Other Inflammatory Lesions, and Pancreatic Pseudotumors. Surg Pathol Clin 2011; 4:625-650. [PMID: 26837491 DOI: 10.1016/j.path.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The pancreas is versatile in the diversity of disorders that it can exhibit. In this article, characteristics of disorders such as chronic, autoimmune, eosinophilic, hereditary, and infectious pancreatitis are described. With regard to autoimmune pancreatitis, the role of clinical evaluation, histologic examination, and IgG4 immunohistochemistry is discussed. The role of pancreatitis in the pathogenesis of diabetes is also mentioned. Some implications of pancreatitis are highlighted, including the neoplastic predisposition caused by inflammatory lesions of the pancreas. The goal of this article is to convey an appreciation of these disorders because their recognition can benefit patients tremendously, as inflammatory lesions of the pancreas can be mass-forming, giving rise to pseudotumors, and leading to surgical resection that may otherwise be unnecessary.
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Affiliation(s)
- Alton B Farris
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University, 1364 Clifton Road Northeast, Room H-188, Atlanta, GA 30322, USA.
| | - Olca Basturk
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - N Volkan Adsay
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road NE, Room H-180B, Atlanta, GA 30322, USA
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Abstract
Chronic pancreatitis (CP) is a disabling condition worldwide that presents as pain, maldigestion, and diabetes. It is usually perceived as alcohol related, or classified as idiopathic otherwise. However, this is true only for Western countries. Asian CP comprises not only alcohol-related CP but also tropical pancreatitis (TP). Tropical pancreatitis is a unique entity commonly found in South Asia. It shares similar presentations with other CPs for pain and maldigestion. However, its diabetes is more ketosis resistant. Non-surgical approach like endoscopic therapy plus extracoporeal shock wave lithotripsy provides better outcome for TP than other CPs, because of its less strictured pancreatic duct that is more amenable to endoscopic stone clearance. Diagnosis of CP in Asia mainly relies on image studies such as ultrasonography ± computed tomography (CT) scan, and non-invasive tests on fecal chymotrypsin, serum trypsin, and serum pancreatic isoamylase. Endoscopic ultrasonography and intestinal tubing tests are used mainly in some research centers. Autoimmune pancreatitis (AIP) is another CP originated from Asia in large series and subsequently being recognized in the West. AIP patients seldom present with maldigestion until the disease progresses to a very late stage and this occurs in less than one third of patients. In contrast, AIP is usually presented as pseudotumor of the pancreatic head, causing obstructive jaundice. Immunoglobulin G4 level is typically elevated in AIP and can be used as a marker for responsiveness. Without a need of surgery, steroids are the standard treatment. Those who relapse and are resistant to steroids should be placed on long-term immunosuppressive agents.
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Affiliation(s)
- Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Abstract
OBJECTIVE The purpose of this review is to describe the epidemiologic, etiopathogenetic, clinical, and imaging characteristics of various nonalcoholic, nonbiliary pancreatitis syndromes. CONCLUSION The spectrum of nonalcoholic, nonbiliary pancreatitis includes autoimmune pancreatitis, groove pancreatitis, hereditary pancreatitis, tropical pancreatitis, tuberculous pancreatitis, and metabolic pancreatitis. Advances in genetics and molecular pathology have shed new light on the etiopathogenesis and course of these syndromes. Accurate diagnosis aided by imaging findings allows optimal management.
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Morken MH, Lind RA, Valeur J, Wilhelmsen I, Berstad A. Subjective health complaints and quality of life in patients with irritable bowel syndrome following Giardia lamblia infection: a case control study. Scand J Gastroenterol 2009; 44:308-13. [PMID: 19031266 DOI: 10.1080/00365520802588091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Irritable bowel syndrome (IBS) is associated with unexplained medical symptoms, and the degree of somatic comorbidity may indicate whether the aetiology of IBS is predominantly psychological or biological in origin. The purpose of this study was to examine the comorbidity and quality of life of patients with IBS following infection with Giardia lamblia. MATERIAL AND METHODS Sixty-seven consecutive patients with persistent abdominal symptoms, initiated by an acute infection with G. lamblia, completed questionnaires for scoring of subjective health complaints (SHC) and quality of life (Short-form Nepean Dyspepsia Index (SF-NDI)). The scores were compared with corresponding scores in persons from the general population (n=70). RESULTS Compared with controls, each of the two groups of patients, those with present (n=17) and those with cured (n=50) G. lamblia infection, had significantly higher scores (p<0.0001) on SHC. However, subscores on somatic comorbidity (musculoskeletal pain) were low and similar to those in the general population (OR 1.2 (0.51-2.73)). Quality of life was substantially impaired in the patients; sum scores 30.0+/-8.0 (mean+/-SD) and 31.7+/-9.3 in the patient groups and 13.5+/-6.8 in the general population (p<0.0001). CONCLUSIONS Patients with post-giardiasis IBS suffer very little somatic comorbidity, suggesting that the aetiology of this form of postinfective IBS is predominantly biological in origin and may thus differ from the more common, non-postinfective forms of IBS. The combination of persisting abdominal symptoms and psychological distress might be a perpetuating factor contributing to low quality of life.
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Affiliation(s)
- Mette H Morken
- Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway.
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Bhasin DK, Singh G, Rana SS, Chowdry SM, Shafiq N, Malhotra S, Sinha SK, Nagi B. Clinical profile of idiopathic chronic pancreatitis in North India. Clin Gastroenterol Hepatol 2009; 7:594-9. [PMID: 19418608 DOI: 10.1016/j.cgh.2009.01.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tropical pancreatitis, a form of idiopathic chronic pancreatitis (ICP) with unique features, has been described in South and North India. We investigated the clinical profile of ICP patients in North India. METHODS Detailed demographic data were recorded; hematological and biochemical analyses were performed on samples from 155 patients (mostly from North India) who had been diagnosed with chronic pancreatitis. Ultrasonography and computed tomography were performed on all patients. Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, glucose tolerance tests, and fecal fat studies were performed on some patients. Patients were divided into groups based on early- or late-onset ICP (before or after 35 years of age). RESULTS ICP was reported in 41.3% of patients and alcoholic chronic pancreatitis in 38.1%. The mean age of ICP patients was 33.0 +/- 13.0 years and the mean duration of symptoms at the time of presentation was 40.2 +/- 34.4 months. Pain was the dominant symptom in patients with early- (95.1%) and late-onset (100%) ICP; pseudocyst was the most common local complication. Diabetes was observed in 17.1% of patients with early-onset ICP and 34.8% with late-onset ICP. Pancreatic calcification was noted in 46.3% of patients with early-onset and 47.8% with late-onset ICP. Pseudocyst and segmental portal hypertension occurred more frequently in non-calcific ICP, whereas diabetes mellitus and abnormal fecal fat excretion occurred more frequently in patients with calcific ICP. CONCLUSIONS In North India, ICP differs from the classical tropical pancreatitis described in the literature. It is associated with a higher prevalence of pain and lower frequencies of diabetes, calcification, and intraductal calculi.
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Affiliation(s)
- Deepak K Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Siddiqui UD, Jamidar PA. Endoscopic therapy for the treatment of pain in chronic pancreatitis: a success story in tropical pancreatitis. Gastrointest Endosc 2007; 66:76-8. [PMID: 17591477 DOI: 10.1016/j.gie.2007.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 05/06/2007] [Indexed: 12/10/2022]
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