Idiopathic chronic calcific pancreatitis in a child: An uncommon entity
A seven-year-old boy was examined in the outpatient department with pain in abdomen. Pain was in the epigastric region, radiating to the back and episodic since one year. There was no history of associated vomiting. These episodes of pain were managed at home. There was no history of drug intake or trauma. There was no family history of chronic abdominal problem. On examination the child was average built without any epigastric tenderness or abdominal distension. Vital signs were within normal limits. There was mild pallor. Results of laboratory studies were within normal limits; the exception was raised amylase and lipase concentrations. Serum amylase level was raised (205 U/L)(N 28 - 100U/L). Serum lipase value was also raised 113U/L (N 5 - 31U/L). Serum calcium, glucose, triglyceride levels were normal (9.8 mg/dl, 86 mg/dl and 150 mg/dl respectively). An abdominal sonogram revealed dilatation of the main pancreatic duct (MPD) with calcifications and multiple cystic areas. Computed tomography (CT) scan of the patient showed heterogeneous attenuation of pancreas with multiple coarse calcific foci throughout the pancreatic parenchyma. MPD was dilated and tortuous and measured 9 mm in the body and tail (modified CT score 4) []. Magnetic Resonance Cholangio Pancreatography revealed atrophic pancreas with grossly dilated and tortuous main pancreatic duct. Hypointense filling defects suggestive of calculi were also seen in the body and tail. The side branches were also dilated [].