Typical Case 1:Alcoholic Chronic Pancreatitis
Brief history:a 43-year-old man complained of steatorrhea for 3 years and upper abdominal pain for the last 15 days.Three years ago，he presented with yellowish-brown，loose and fatty feces 4-5 times daily after eating greasy food，which was alleviated by dietary management and oral digestive enzyme replacement.However，steatorrhea has been aggravated for the last 2 months.In the local hospital，CT showed chronic pancreatitis，pancreatic duct stones，biliary duct stones，and the main pancreatic duct dilatation.No treatment was given then.Half a month ago，the patient presented with severe upper abdominal pain radiating to the back，and was treated according to the diagnosis of an acute episode of chronic pancreatitis in the local hospital.After the pain was relieved partially，he had his admission to our department for further management.
Past history:type 2 diabetes with a normal blood glucose level controlled by insulin regimens for 12 years，regular consumption of 50 g alcohol daily for 20 years as well as of 150 cigarettes annually for 15 years.
Physical examination:no significant signs.
Laboratory parameters:normal blood lipid level，negative results of CEA，CA1 9-9，IgG4 and autoimmune antibodies.
CT and contrast-enhanced CT:pancreatic atrophy，marked dilatation of the pancreatic duct with irregular changes in caliber，multiple highdensity shadows in the pancreatic head，and a patchy high-density shadow in the pancreatic tail（Fig.13.1）.
Diagnosis:chronic pancreatitis with pancreatic duct stones，type 2 diabetes，exocrine pancreatic insufficiency.(https://www.daowen.com)
Treatment process:ESWL was performed on June 28，2012 and July 2 respectively，and ERCP+EPT+stone extraction was carried out on July 4（Figs.13.2 and 13.3）.The patient recovered well shortly afterwards.
Fig.13.1 （a）CT revealed marked dilatation of the pancreatic duct with irregular changes in caliber，and a patchy high-density shadow in the pancreatic tail（arrow）.（b）Contrast-enhanced CT revealed pancreatic atrophy，and multiple high-density shadows in the pancreatic head（arrows）
Fig.13.2 （a）Endoscopy showed the major papilla on the descending duodenum before ERCP.（b）Endoscopy showed stone extraction from the papilla via retraction of the catheter with an inflated balloon after EPT