The Opioid-Tolerant Patient

A 21-year-old male patient was seen prior to total pancreatectomy and auto islet cell transplantation for intractable abdominal pain secondary to recurrent pancreatitis. He was noted to have hereditary pancreatitis due to a PRSS1 mutation. He had a 10-year history of episodic abdominal pain that had been increasing in frequency and intensity in the year leading up to the current evaluation. He had a normal glucose tolerance test, and on his most recent surgical consultation, it was reported that he had no evidence of diarrhea, steatorrhea, or weight loss. Consequently, he was deemed to have normal exocrine and endocrine pancreatic function. He had been diagnosed with ulcerative colitis in the preceding year based on clinical findings and colonoscopy.