Recurrent Abdominal Pain Research Articles

Genital Tuberculosis in a Nigerian Woman with Primary Infertility

We present a 30-year-old nullipara with a two-year history of inability to conceive and a 30-month history of recurrent lower abdominal pain. A transvaginal ultrasound scan showed a right complex adnexal mass measuring 70 cm × 65 cm; tumor makers were essentially normal aside marginally elevated CA-125. She subsequently had exploratory laparotomy with right salpingo-oophorectomy, and a histopathology examination of the specimen revealed caseous necrosis, granuloma formation with a rim of the Langhans giant cells within the wall of the fallopian tube. Serum tuberculosis (TB) QuantiFERON was also positive for Mycobacterium tuberculosis. She is currently on anti-Koch’s and is responding to treatment. This case report aims to highlight the need for exploring other causes of chronic pelvic pain and primary infertility when evaluating women with similar history in our environment, especially in TB endemic areas.

Initial experience with laparoscopic revisional single anastomosis duodeno-ileal bypass (SADI-S) after failed sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG. To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up. This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery - revisional SADI-S - in 2021 at a secondary referral public hospital. All patients' follow-up was completed 1 year after. 14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96-77.16) kg/m2, BMI before SADI-S was 43.09 (41.64-48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29-39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25-21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18-41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension. SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.

Emergency laparoscopic surgery on a patient who visited the emergency room with lower abdominal pain

Internal hernias account for fewer than 6% of all small intestinal obstructions; of these, hernias caused by defects in the sigmoid colon are particularly challenging to detect. Misdiagnosis may occur if non-surgical symptoms (such as rebound tenderness) are not observed in the emergency room. We report the case of a consent who visited the emergency room with recurrent non-specific lower abdominal pain. She exhibited an internal hernia that had triggered small intestinal ischemia between the mesosigmoid (mesentery) and ovary. A 36-year-old female patient visited the emergency room of our hospital with acute left-lower abdominal pain, nausea, and vomiting that occurred 1 h after meals. We found no palpable mass or enlarged organ. Abdominal computed tomography (CT) revealed segmental small bowel wall thickening with mesenteric congestion in the left-lower quadrant, and small bowel ischemia attributable to internal herniation or adhesion. In addition, a small amount of pelvic ascites and multiple liver cysts were observed. A surgeon was immediately consulted and emergency laparoscopic surgery was performed.

Internal Hernia with Volvulus – A Rare Cause of Recurrent Abdominal Pain after Frey’s Procedure

Acquired internal hernia can be a rare cause of abdominal pain after Frey’s procedure for chronic pancreatitis. The presentation and imaging findings can be non-specific and there should be a high index of suspicion in dealing with these patients. The delay in diagnosis can be catastrophic in some cases, as the bowel can undergo volvulus and gangrene. Prompt surgical treatment is the key to avoid major morbidity and mortality.

ЭНТЕРОПАТИИ С НАРУШЕНИЕМ МЕМБРАННОГО ПИЩЕВАРЕНИЯ И СИНДРОМ РАЗДРАЖЕННОГО КИШЕЧНИКА – СОЧЕТАННАЯ ПАТОЛОГИЯ

The article describes the clinical manifestations and their causes in the pathology of the small intestine in patients who complain of excessive bloating, recurrent abdominal pain syndrome, stool disorders with a tendency to relaxation. Such patients repeatedly return to the doctor. The evidence of a decrease in the activity of disaccharidases in this cohort of patients is presented. The emphasis is placed on the need to study the nutritional history, to identify products that provoke a violation of membrane digestion. The classification of carbohydrates with indication of products containing them is given. The essence of repeated and persistent clinical manifestations due to impaired membrane digestion and absorption of carbohydrates in the small intestine is explained, which leads to their appearance in the large intestine in different volumes, which is accompanied by the splitting of carbohydrates with the formation of gases. On the one hand, this is a normal process, but when it gets out of control, the patient gets to the doctor. The essence of a carbohydrate–restricted diet is described - this is the low FODMAP diet and its decoding. The products containing oligosaccharides are indicated, which are capable of being cleaved by the enzyme alpha-galactosidase, which is absent in the human body, but is present in the microflora of the large intestine. Advice is given on limiting the intake of such products, both in terms of the frequency of intake and the volume of portions containing them, in order to avoid excessive amounts of intestinal gases, the development of a clinically painful condition. A thorough study of the nutritional history and the necessary correction of eating behavior is the main idea of this article, dedicated to the same type of clinical picture with varying degrees of manifestations of its symptoms.

Грыжа спигелиевой линии как причина рецидивирующего абдоминального болевого синдрома неясной этиологии

The spigelian hernia is a rare pathology in pediatric practice. The analysis of all available publications has been carried out since the first description of this disease in children, the features of its clinical picture, diagnostic criteria and surgical tactics have been determined. The inclusion of the spigelian hernia in the list of diagnoses that must be excluded in case of recurrent abdominal pain will allow timely detection of this disease in children, timely surgical care, reduce the number of complications and improve the quality of life. Key words: abdominal pain syndrome of unclear etiology, spigelian hernia, children, laparoscopic hernia repair, testicular spigelian dystopia syndrome, traumatic hernia, ultrasound signs of hernia

Multiple small intestinal ulcers with SLCO2A1 mutation in a Chinese patient.

A 31-year-old man was admitted to our hospital due to recurrent abdominal pain and intermittent melena for 9 years. He also suffered from skin thickening and digital clubbing since adolescence (Fig. 1A and B). He denied intake of non-steroidal, anti-inflammatory drugs. Blood tests revealed normocytic normochromic anemia (hemoglobin, 110 g/dL). Other examinations such as T-SPOT.TB, autoantibody biomarkers, cytomegalovirus, Epstein-Barr virus, and growth hormone level were normal. X-ray showed irregular cortical thickening of the tibiofibular and hand (Fig. 1C).

Unexpected cause of chronic recurrent abdominal pain: mesenteric arteriovenous dysplasia/vasculopathy.

We would like to submit the manuscript entitled "Unexpected Cause of Chronic Recurrent Abdominal Pain: Mesenteric Arteriovenous Dysplasia/Vasculopathy" for publication in REED. Mesenteric arteriovenous dysplasia/vasculopathy (MAVD/V) MAVD/V is a rare, localized, noninflammatory, non-atherosclerotic form of mesenteric vasculopathy that involves both arteries and veins producing secondary ischemic changes and alterations in the intestinal mucosa. It was proposed for the first time in 2016. Chronic abdominal pain is the most common symptom, which tends to progressively aggravate, and can be accompanied by weight loss, diarrhea or constipation and bloody stools, only a few patients begin with acute abdominal pain.

Prevalence of Helicobacter Pylori in Children with Recurrent Abdominal Pain

Background: In children the recurrent abdominal pain is a commonest reason for seeking medical care. In various studies, H pylori and abdominal pain were shown to be significantly correlated in paediatric patients. Objective: To assess the prevalence of helicobacter pylori in children with recurrent abdominal pain Methodology: The current cross sectional study was carried out at the Pediatrics department Sandeman Provincial Hospital Quetta from March 2022 to August 2022. The research included all children with recurrent abdominal pain (according to Rome II criteria) who met the inclusion requirements. Under strict aseptic conditions, five milliliters of blood were taken and sent to the hospital laboratory for ELISA-based H pylori identification. All the information was entered into a predesigned proforma. For the analysis of data, IBM SPSS version 23 was used. Results: In our study, totally 150 children who met the inclusion criteria were enrolled. The male children in our study were 108 (72%) while female children were 32 (28%). The mean age (±SD) was 10 (±4.36) years. Based on ELISA, the helicobacter pylori prevalence was 39 (26%) in children with recurrent abdominal pain. Conclusion: Our study concludes that the in children with recurrent abdominal pain, the helicobacter Pylori prevalence is very high. All the children who visit the pediatrics clinics and having recurrent abdominal pain should be diagnosed for helicobacter pylori. Keywords: Prevalence; helicobacter pylori; children; recurrent abdominal pain

A Typical Case of Familial Mediterranean fever in a War Survivor with Post-Traumatic Stress Disorder of Caucasian Descent Treated with Standard Colchicine Therapy

Objective: A rare case of FMF with atypical presentation of fever attacks lasting 7 days predominantly evident after the war has been described. Usually, the FMF bouts last for 3-4 days but the unusual presentation of our patient led to the initial misdiagnosis of PTSD (Post traumatic stress disorder). Patient and Method: A case of a 38-year-old former Armenian soldier who participated in a 44-day long war with Azerbaijan showing symptoms of recurrent fever, thoracic and abdominal pain predominant only on the left hypochondriac, lumbar and inguinal region. The changes in the laboratory examination were not significant. A wide range of diagnostic tests like X-Ray, CT, and MRI performed all of which were inconclusive. Result: The diagnosis was confirmed after 5 years by positive molecular genetic testing for the MEFV gene. The patient was given colchicine 1 mg/kg/day which reduced the severity and frequency of attacks. Conclusion: The atypical presentation of FMF with prolonged fever lasting up to 7 days, no familial history, post-war trauma, and pain only on the left side led to the differential diagnosis excluding FMF.FMF was suspected when his blood analysis showed acute phase reactants returned to normal after the 7-day attack period. He was started on colchicine therapy and showed a positive response which led to the diagnosis of FMF. The positive MEFV genetic testing confirmed the diagnosis. Clinicians should not exclude the possibility of FMF in patients who do not show the classic fever attack period of 3 to 4 days.

Spectrum of Upper GI Endoscopy in Children: A Tertiary Centre Experience from Bangladesh

Background: Upper gastrointestinal endoscopy is an essential, safe and sensitive investigation for diagnosing pediatric gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. There is limited study on paediatric upper GI endoscopy in our country.
 Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.
 Methods: This is a retrospective study; the records of all the patients whose age is less than 18 years and who underwent endoscopy in the last 6 years were studied.
 Results: Among the total of 384 children (age <18 years), the most common indications were recurrent abdominal pain in 133 (34.7%) patients followed by hematemesis±melena in 99 (25.8%), esophageal varices (follow up with eradication) in 67 (17.5%), recurrent vomiting in 31 (8.1%), foreign body, CLD screening, suspected celiac disease, isolated splenomegaly, corrosive injury, and weight loss. The most common abnormal findings were gastritis in 103 (26.9%) children followed by esophageal varices in 73 (19.2%), duodenitis in 26 (6.8%), foreign body, esophagitis, hiatus hernia, esophageal stricture, esophageal ulcer, gastric ulcer, duodenal ulcer etc. Minor adverse events occurred in 7.0% of children.
 Conclusion: The commonest indication for Pediatric UGI endoscopy was recurrent abdominal pain and the commonest endoscopic feature was gastritis. No significant post procedure complication was noted in the study.
 DS (Child) H J 2021; 37(2): 123-128

Indolent T-cell lymphoproliferative disorder of gastrointestinal tract with unusual clinical courses: report of 6 cases and literature review.

Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract (iTLPD-GI) is a rare neoplasm usually having an indolent clinical course and easily misdiagnosed as inflammatory bowel disease or other T-cell lymphomas. A subset of the disorders that progressed to overt peripheral T-cell lymphoma have been reported, and the etiology and pathogenesis are poorly understood. The current study retrospectively examined the pathological, molecular, and clinical features of 6 cases of iTLPD-GI. Hematoxylin and eosin staining, immunohistochemistry, in situ hybridization, T-cell receptor gene rearrangement, and next-generation sequencing (NGS) were performed with the diseased tissues. All the 6 patients were immunocompetent Chinese men, who presented with recurrent abdominal pain and diarrhea for 4 to 13years. Histologically, the intestinal tissue was expanded by lymphoid infiltration, composed of small-to-medium-sized lymphocytes with gland intact. The neoplastic cells were CD4 - /CD8 + with expression of TIA1 and variable granzyme B in five cases, and the other one was CD4 + /CD8 - . Two of the 5 patients progressed to more aggressive T-cell lymphoma and died of disease with complications. NGS identified TET2 and DDX3X mutations in patient 1, and BIRC6 and REV3L mutations in patient 2. Literature review indicated that iTLPD-GI with CD4 - /CD8 + immunophenotype was more commonly reported in Chinese cases. Our limited data indicated CD4-/CD8 + iTLPD-GI have similar potential to progress to more aggressive T-cell lymphoma as that of CD4 + /CD8 - , and gradually increased expression of granzyme B and Ki-67 may be early signs of the disease progression. Gain of novel gene mutations may be indicators of the pathogenesis.

A case report of encapsulating peritoneal sclerosis followed by cesarean section: Clinical diagnosis and treatment experience

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome, is an uncommon condition that typically presents with features of bowel obstruction. EPS followed by cesarean section is extremely rare. Intestinal obstruction caused by EPS lacks specificity and poses clinical difficulties for diagnosis and treatment. We present the case of a patient with recurrent intestinal obstruction followed by cesarean section, and the diagnosis of EPS was confirmed intraoperatively. The patient recovered well postoperatively, and achieved satisfactory therapeutic results. Management of this condition tests the surgeon's knowledge and experience of the disease. A 27-year-old woman with recurrent abdominal pain and distention accompanied by reduced anal discharge and defecation there months. The patient had a history of cesarean section 4 months earlier and recovered well after operation. She had no other history of abdominal surgery or diseases. On examination, a 10-cm long transverse incision was made in the lower abdomen, and marking on the intestinal movements were observed in the left mid-abdomen. A long, soft lump with good mobility was touched in the left lower abdomen. The abdominal computed tomography and small bowel barium meal examination revealed incomplete intestinal obstruction. Incomplete small bowel obstruction due to abdominal adhesions after the cesarean section was initially considered. After conservative treatment, the symptom of intestinal obstruction still recurred. Thus, we decided to perform a surgery of repeated decortication of fibrous peritoneal membranes. The operation successfully released the intestinal obstruction and abdominal pain, postoperative course recovered smoothly. After cesarean section could develop EPS. Intestinal obstruction caused by EPS lacks specificity and poses clinical difficulty in diagnosis and treatment. The management of this condition tests the surgeon's knowledge and experience, and surgery is an effective treatment measure.

Application of capsule endoscopy in patients with chronic and recurrent abdominal pain: Abbreviated running title: capsule endoscopy in abdominal pain.

The incidence of chronic and recurrent abdominal pain increases every year, while the diagnosis is still unsatisfactory even after a number of check-ups. This study aimed to evaluate the diagnosis value of capsule endoscopy in patients suffering from chronic and recurrent abdominal pain. A retrospective case study was performed in 80 chronic and recurrent abdominal pain patients at Xiangyang Central Hospital from January 2013 to November 2017. Meanwhile, diagnoses by capsule endoscopy were collected for analysis. Abnormal findings were found in 54 of 80 (67.5%) patients. The findings in chronic and recurrent abdominal pain patients include small intestinal erosion and congestion, small intestinal ulcers, small intestinal parasites, small intestinal vascular malformations, small intestinal polyps, small intestinal diverticulum, and small intestinal lymphangiectasia. There were no immediate significant side effects without being reported up to 1 month after ingestion of the capsule. The capsule was evacuated by all patients. Capsule endoscopy has a great value in the diagnosis of chronic and recurrent abdominal pain with satisfactory safety and less pain for patients. Inflammatory lesions and ulcers in the small intestine account for the majority of positive findings in these patients.

Temporal lobe epilepsy manifests refractory recurrent abdominal visceral pain in a 7-year-old children

Refractory Recurrent abdominal visceral pain (RAVP) is a severe condition and can be difficult to diagnose and manage due to its poorly understood pathophysiological mechanisms. Here we report a 7-year-old patient with a 2-year history of temporal lobe epilepsy manifesting refractory RAVP. The patient was treated with anterior temporal lobectomy (including the amygdala and the hippocampal formation), and the pain resolved completely after surgery. The patient remained free of seizures and pain during 4 years of post-surgery follow-up. Based on this case and previous studies, we speculate a central mechanism and neuromodulation target for refractory visceral pain.

Acute Intermittent Porphyria with Recurrent Abdominal Pain and Epilepsy: A Case Report

<p>急性間歇性紫質症是一種罕見的遺傳性代謝異常疾病。本案例是一位38歲女性病人，起初反覆性腹痛合併噁心、嘔吐、腹瀉之表現，後續發生癲癇大發作及急性呼吸衰竭，經實驗室檢驗及影像檢查，僅呈現低血鈉、白血球增加，其他無異常發現。由於發現尿液偏褐色，進一步檢驗發現尿液中高胺基酮戊酸、高膽色素原，以及血液中低膽色素原脫胺酶，確診急性間歇性紫質症，經血基質治療後臨床症狀逐漸改善並順利出院。針對此類以腹痛合併癲癇表現的病人，且與低血鈉之徵象並存時，必須將急性紫質症列為鑑別診斷之一，以免延誤治療時機。</p> <p> </p><p>Acute intermittent porphyria is a rare genetic metabolic disease. In this case, a 38-year-old female pa-tient who experienced recurrent abdominal pain with nausea, vomiting, and diarrhea, following with epileptic seizures and acute respiratory failure. After the laboratory and image examinations, hypona-tremia and leukocytosis were only noted without other abnormal findings. Because of brownish urine, further laboratory examinations were performed. High level of aminolevulinic acid and porphobilino-gen of urine, and low level of porphobilinogen deaminase of blood were revealed. Acute intermittent purpura was diagnosed eventually. After human hemin treatment, the clinical symptoms gradually im-proved, and the patient was then discharged. For such patient with abdominal pain, refractory epilepsy, and coexisting hyponatremia, acute intermittent purpura should be considered as differential diagnosis for punctual treatment.</p> <p> </p>

Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report

Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy. Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus. Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.

S123 Maternal and Fetal Outcomes After IBD Surgery During Pregnancy

Background: Inflammatory bowel disease (IBD) incidence peaks in the reproductive years. Despite advances in medical treatment, approximately 20% of ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients require surgical intervention during their lifetime. Active disease during pregnancy increases the risk of negative pregnancy outcomes, such as spontaneous abortion, low birth weight, prematurity and deformities. Achieving remission prior to conception and maintaining it throughout the pregnancy remain of utmost importance. However, surgery during pregnancy may be required for medically refractory disease or for disease-related complications such as intraabdominal abscess, perforation, or toxic megacolon. Literature pertaining to the maternal and fetal outcomes after IBD surgery during pregnancy remains scarce. Methods: This is a case series of 3 patients who underwent surgery for IBD during pregnancy and subsequently delivered at our quaternary IBD referral center. Results: Case 1: A 34-year-old female with recently diagnosed indeterminate colitis presented with disease exacerbation during her fifth gestational week. Despite treatment with mesalamine, methylprednisolone, and infliximab, she had persistent hematochezia, abdominal pain, and distention. On 11w6d of pregnancy, she underwent an open subtotal colectomy with end ileostomy for severe colitis. Postoperative period was uncomplicated. She then underwent a C-section at 38w5d of gestation. Baby weighed 2.9 kg, Apgar scores 9-9. The newborn had a cleft in the posterior soft palate, micrognathia, tongue tie, and laryngomalacia resulting in dyspnea and dysphagia, which required operative intervention during infancy. The mother ultimately underwent completion proctectomy with IPAA and ileostomy closure at 5- and 7-months following delivery, respectively. Postoperative pouch function was normal. During routine follow-up, pouchoscopy revealed cuffitis, which responded to mesalamine suppository. Case 2: A 28-year-old female with an 8-year history of UC previously treated with prednisone and azathioprine developed disease exacerbation during her 11th gestational week. During 25th week of pregnancy, she underwent an open subtotal colectomy with end ileostomy for acute severe ulcerative colitis. Postoperative period was uncomplicated. She underwent C-section at 39th week of gestation. Baby weighed 3.7 kg, Apgar scores 3-3-8. The newborn developed dyspnea which was resolved following positive pressure ventilation in the NICU for 30 hours. The mother underwent completion proctectomy with IPAA and ileostomy closure 2 years after delivery. Four years following pouch creation, she developed pouchitis, which was controlled with vedolizumab. Case 3: A 20-year-old female with recently diagnosed Crohn’s disease had disease exacerbation at 4 weeks gestation despite treatment with adalimumab and prednisone. A pelvic abscess was identified via ultrasound requiring percutaneous drainage twice. During the ninth week of pregnancy, she underwent a laparoscopic converted to open ileocecectomy due to recurrent abscess and abdominal pain. Postoperative period was uncomplicated. The pregnancy was complicated by pre-eclampsia in the third trimester. The patient had a vaginal delivery at 37w6d of gestation. Baby weighed 2.7 kg, Apgar scores 8-9. The post-delivery course of the mother and infant was uncomplicated. Conclusions: IBD affects females during their childbearing ages. IBD surgery at times needs to be done urgently/emergently; acceptable maternal and fetal outcomes can be achieved.

Small bowel intussusception caused by a serrated adenoma: a case report.

The case was a 17-year-old young woman with a one-year history of recurrent abdominal pain and discomfort. B-scan ultrasonography identified intussusception and contrast-enhanced computed tomography of the pelvis revealed volvulus. A laparoscopic procedure was planned to identify the reason for the intussusception and obstruction. Intraoperatively, the intussusception was found to be caused by a cauliflower-shaped polypoid tumor measuring approximately 4 × 3 cm. Postoperative pathological examination identified the tumor to be a traditional serrated adenoma of the small intestine, which is rare and has atypical clinical manifestations. If unexplained abdominal pain or gastrointestinal bleeding occurs and an abdominal mass cannot be accurately located, laparoscopic or open surgery should be performed immediately. Early surgery is the most effective and reliable way of securing a prompt diagnosis and a favorable prognosis.

Pancreatic Stones in Children with Chronic Pancreatitis: A Case Report

Background: Chronic pancreatitis is a continuous progressive inflammation of the pancreas that can cause recurrent abdominal pain. The incidence of chronic pancreatitis in children is on an upward trend in recent years. The purpose of this case report is to enhance clinician's insight in considering chronic pancreatitis as a differential diagnosis in cases of recurrent abdominal pain in children. Case: We reported a case of chronic pancreatitis with pancreatic stones in a 12-year-old child. The patient came with complaints of recurrent upper left abdominal and heartburn accompanied by nausea and vomiting. Epigastric and left hypochondriac tenderness were found. Laboratory examination showed an increase in pancreatic enzymes up to 6x the normal value. The results of abdominal CT-scan and MRCP showed multiple pancreatic stones with pseudocysts. The patient then underwent the Puestow procedure. Postoperatively, the complaints of abdominal pain resolved and the pancreatic enzymes improved significantly. Discussion: The diagnosis of pancreatitis must meet 2 out of the 3 criteria that have been determined. Primary management includes fluids, analgesics, early nutrition, and surgery in cases of chronic pancreatitis accompanied by complications such as pseudocysts or pancreatic stones. Conclusion: This case teaches the need for a careful clinical approach and consideration of chronic pancreatitis as a differential diagnosis in a child with recurrent abdominal pain.