Typical Case 2:Chronic Pancreatitis with Main Pa...
Brief history:a 47-year-old man complained of recurrent upper abdominal pain for 14 years with a recent bout for the last 4 days.In 1997，he presented with severe upper abdominal pain which radiated to the back right after drinking and was treated according to the diagnosis of acute pancreatitis in the local hospital.Since then，the similar symptom had recurred 3-4 times annually because of drinking or high-fat diets，requiring hospitalization each time.The patient could be free from any symptoms at the remission stage.In 2007，he was diagnosed as chronic pancreatitis since MRCP in our hospital demonstrated pancreatic atrophy and main pancreatic duct dilatation.Therefore，ERCP+pancreatic duct stent placement was performed and the symptom was improved significantly.Then he had periodical check-ups every year，underwent stent exchanges for several times，and took Creon，Nexium and Tylox intermittently.Due to a recent bout of abdominal pain，this man was admitted to our department for further management on June 13，2011.
Physical examination:soft abdomen with epigastric tenderness，no rebound tenderness or guarding.
Laboratory parameters:CEA 5.63 ng/mL，triglyceride 3.72 mmol/L，total cholesterol 6.09 mmol/L，blood glucose 10.8 mmol/L，HbAlc 11.4%，and serum amylase 315 U/L.
Fig.13.3 （a）ERCP demonstrated irregular dilation of the entire pancreatic duct and multiple filling defects in the head and body of the pancreatic duct.（b）X-ray demonstrated the disappearance of filling defects after stone extraction
Fig.13.4 CT revealed mild pancreatic atrophy，relatively low density in the body and tail of the pancreatic parenchyma with poorly defined organ margins，and segmental dilatation of the main pancreatic duct without stones
CT:mild pancreatic atrophy，relatively low density in the body and tail of the pancreatic parenchyma with poorly defined organ margins，and segmental dilatation of the main pancreatic duct without stones（Fig.13.4）.(https://www.daowen.com)
MRCP:segmental dilatation of the main pancreatic duct，mild peripancreatic fluid collections with the pancreas poorly demarcated（Fig.13.5）.
Diagnosis:an acute episode of chronic pancreatitis，secondary diabetes.
Treatment process:antacids，trypsin inhibitors and fluid replenishment were administered immediately.ERCP+pancreatic duct stent placement was performed on June 20，2011（Figs.13.6 and 13.7）.