Recurrent Acute Pancreatitis and Cholangitis in a Patient with Autosomal Dominant Polycystic Kidney Disease
A 38-year-old man was transferred to the emergency department (Alzahra hospital, Isfahan University of Medical Sciences) with an acute abdominal pain, nausea and vomiting in early September 2010. His abdominal pain was mainly localized in the epigastric region and had a tendency to worsen in the supine position.\nHe was a known case of ADPKD with multiple renal cysts since 12 years ago. The patient had been hospitalized five times in our center in the past 11 months with the same symptoms and with the diagnosis of acute pancreatitis that each time he had been managed with conservative treatments. Multiple hepatic cysts had been detected in the past year during pancreatitis workup. He had also a history of stent placement and retrieval for two times because of stricture formation in common bile duct and consequent cholangitis.\nPhysical examination revealed generalized jaundice, tachycardia and tenderness in upper abdomen. Laboratory study was demonstrated in . There was no evidence of gallstone in abdominal ultrasonography. Abdominal computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP) and abdominal magnetic resonance imaging (MRI) revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone [Figures –].\nWith the diagnosis of acute pancreatitis, the patient was treated with conservative treatments included hydration and antibiotics. We also evaluated the patient for intracranial, cardiac and gastrointestinal association of ADPKD which revealed no considerable finding. He was discharged after a week with remarkable decrease in clinical and laboratory impairments and without need for surgery. After three months as the patient had recurrent cholangitis he underwent a liver transplantation. Two months later, he was hospitalized again with another attack of acute pancreatitis.