Case Report: Recurrent Pancreatitis-Challenges in Management

Abstract

Background Recurrent Acute Pancreatitis (RAP), is an uncommon clinical condition, usually seen in the setting where the underlying risk factors remain unresolved. Diseases of the pancreas peak in the 3rd and 4th decades and are commonly caused by gall-stones (Cholelithiasis) which are detectable by abdominal ultrasonography and computerised tomography. Microlithiasis, a leading cause of RAP, often presents with diagnostic challenges in resource limited settings. Case Report We present a case of a 19 year old female with recurrent bouts of epigastric pain within a two year period. Laboratory investigation revealed fluctuating levels (high and normal) of serum amylase and lipase while repeated abdominal Ultrasonography were normal. Computerised tomography was initially normal but later scans revealed features of pancreatitis. Microlithiasis was identified following Endoscopic Ultrasonography which had to be done outside the shores of the country as this facility is not available in our practice. She had laparoscopic cholecystectomy and after an episode of abdominal pain has remained pain free. Conclusion This case has highlighted the constraints faced by practising physicians as well as the morbidity suffered by patients with this uncommon condition due to non-availability of appropriate diagnostic tools in our setting necessitating our patient seeking assistance abroad. It underscores the need to ensure their availability as well as that of adequate skilled personnel by stakeholders in the health sector. Key Words: Acute Pancreatitis, Microlithiasis, Endoscopic Ultrasound