Abstract
A 57-year-old female was referred to Duke University Medical Center (DUMC) for investigation of recurrent pancreatitis. Her first episode of pancreatitis, which had occurred 3 years earlier, manifested as epigastric pain and a markedly elevated serum amylase level which necessitated hospital admission for 9 days. Her history was negative for relevant pancreatic risk factors including alcohol abuse, medications, family history and hyperlipidaemia. Ultrasound (US) of the gallbladder showed no gallstones. CT of the abdomen showed a swollen head of pancreas with peri-pancreatic inflammatory change and fluid, consistent with pancreatitis. The biliary tree was not dilated. She made a complete recovery and was well until 8 months later when she had recurrent epigastric pain of a similar character with elevation of the serum amylase. She was admitted to hospital for 3 days. A repeat US scan showed no cholelithiasis. Following resolution of her symptoms, she underwent endoscopic retrograde cholangiopancreatography (ERCP) to exclude choledocholithiasis or a pancreatic abnormality. The patient's pancreatogram is shown in Figures 1 and 2. The cholangiogram was reported to be normal. She developed post-ERCP pancreatitis and was referred to DUMC for further evaluation.
Published Version
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