Abstract
Background: Idiopathic chronic calcific pancreatitis is a rare entity. Early surgical intervention and a parenchyma sparing procedure should be advocated to prevent further decay of the pancreas and the occurrence of cancer.Case Presentations: Case 1: A 14-year-old boy presented with a 3-year history of right upper abdominal pain that has been aggravated in the last 2 months. Imaging revealed a dilated pancreatic duct of 6 mm with pancreatic duct stones in the head of pancreas. He underwent a Frey's procedure. Unfortunately, he was discharged with grade B pancreatic fistula. Case 2: A 12-year-old boy presented with a 1-year history of dull and recurring epigastric pain. Imaging studies showed multiple stones in a 12 mm dilated pancreatic duct. The patient underwent a modified Puestow procedure. Up to the 42th month follow-up, the patient had no pain complaints. Case 3: A 12-year-old boy with a 1-week history of a dull epigastric pain presented with with multiple stones in a 10 mm duct. He underwent a modified Puestow procedure and was discharged with alleviated pain.Conclusions: “Conservative” surgery allows satisfactory pancreatic duct drainage, reduced rehospitalizations, and longer pain relief than alternative endoscopic procedures.
Highlights
Chronic calcific pancreatitis (CCP) associated with pancreatic lithiasis is truly a rare finding in children
We present three cases of idiopathic chronic calcific pancreatitis (ICCP) in three children aged 12, 12, and 14 years
Case 1 A 14-year-old boy presented to our center with a 3-year history of right upper abdominal discomfort accompanied by occasional painful episodes
Summary
Chronic calcific pancreatitis (CCP) associated with pancreatic lithiasis is truly a rare finding in children. The pain intensity worsened in January 2019 after the patient contracted a common cold He underwent an abdominal computed topography (CT; Fig. 1a, b) that showed pancreatic duct stones in the body of pancreas and multiple high density calcifications in the head of pancreas; contour of the pancreas was unclear. A magnetic resonance imaging (MRI) indicated a dilated pancreatic duct containing multiple stones in the head pancreas with small amount of abdominal effusion. An MRI report on September 2015 revealed multiple pancreatic duct stones. On the day of admission the patient underwent an abdominal CT that showed unclear gland contour with multiple calcification and small pseudocyst; these features were suggestive of chronic pancreatitis. Despite having no pain on the 21st month follow-up, abdominal CT indicated chronic pancreatitis with dilation of pancreatic duct in contrast to the 7th month abdominal CT. The patient did not suffer from any postoperative complications and was discharged on postoperative day 11 with improved symptoms
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