Electronic Clinical Challenges and Images in GI Acute Pancreatitis: An Uncommon but Easily Treatable Cause

Question: A 28-yearold woman living in a tropical country was admitted with severe upper abdominal pain in the epigastrium radiating to back requiring narcotic analgesics for relief for 5 days. There was no history of ethanol abuse or intake of drugs before the onset of symptoms. Biochemistry showed: hemoglobin, 10.4 gm%; total leukocyte count, 8,600 cells/mm3. The differential showed: polymorphs, 62; lymphocytes, 24; eosinophils, 12; blood urea, 26 mg/dL; serum creatinine, 0.8 mg/dL; blood sugar, 86 mg/dL; total bilirubin, 2.2 mg/dL; SGPT, 120 U/L (normal, 5–50); SGOT, 90 U/L (normal, 5–50); serum alkaline phosphatase; 290 U/L (normal, 25–125); serum amylase, 920 U/L (normal, 20–80); and serum lipase, 560 U/L (normal, 0–190). Abdominal ultrasonography revealed a normal gallbladder and liver with a dilated common bile duct of 9 mm to the distal end without any evidence of calculus or sludge. The pancreatic echo texture was apparently normal. An endoscopic ultrasound revealed a normal common bile duct and showed the following pictures of the pancreas (Figure A–D; Video). What is the diagnosis? See the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest: The authors disclose no conflicts. © 2011 by the AGA Institute 0016-5085/$36.00 doi:10.1053/j.gastro.2010.10.051