A rare cause of recurrent acute pancreatitis

Abstract

QuestionA 72-year-old woman was admitted to our hospital complaining of severe epigastric pain radiating to her back, nausea and vomiting. She had experienced similar complaints three years earlier and had undergone a laparoscopic cholecystectomy in another hospital due to biliary acute pancreatitis. Ten months after the operation, she again suffered attacks of nausea, vomiting and mild abdominal pain. A magnetic resonance cholangiopacreatography (MRCP) was arranged by her surgeon. According to the report, findings showed normal diameter of the common bile duct with no signs of opacification and mild dilatation of the pancreatic duct without other pathological signs (Fig. 1). The patient presented on three more occasions with mild episodes of acute pancreatitis; on her last visit, she displayed abrupt epigastric pain accompanied by jaundice. The patient was readmitted to the same hospital where she underwent an endoscopic cholangiopancreatography (ERCP) with sphincterotomy (Fig. 2).During her hospitalization in our department, a complete re-evaluation was performed. No history of alcohol consumption or medication was noted. Ultrasonography of the abdomen showed slight dilatation of the pancreatic duct and no signs of opacification and dilation of the biliary tree. Laboratory work-up revealed elevated levels of serum amylase ( 3004 U/I ), while serum bilirubin, serum calcium, triglyceride, alkaline phosphatase, antinuclear antibody (ANA), anti-dsDNA and rheumatoid arthritis ( RA) factor levels were found to be normal. Tumour markers were also normal. Due to failure in