Tropical calcific pancreatitis.

Abstract

Tropical calcific pancreatitis is a special type of chronic pancreatitis that has features quite different from those of alcoholic pancreatitis and is seen almost exclusively in tropical countries. It is characterized by recurrent severe pain in the abdomen, insulin-requiring but ketosis-resistant diabetes and large pancreatic calculi in malnourished male adolescents. The clinical course of tropical calcific pancreatitis is protracted with malnutrition, recurrent infections and poorly controlled diabetes. Pancreatic cancer may complicate the natural course in up to 10% of cases. However, in the community a much milder form of the disease occurs with a female preponderance and a prevalence of 0.13% or one in 793. Malnutrition with deficiency of proteins and micronutrients with antioxidant properties and food-based toxins, such as cassava, which contain cyanogenic glycosides have been suspected as possible aetiological factors. Impaired immune response, a presumed infection (possibly viral) and genetic susceptibility are some of the other factors suspected in the aetiopathogenesis of this disease. Besides controlling diabetes with insulin, relief from pain is obtained by the administration of analgesics and pancreatic enzymes and, in severe cases, by performing endoscopic or surgical decompression of dilated pancreatic ducts with removal of pancreatic calculi.