Typical Case 4:Adolescent Chronic Pancreatitis w...
Brief history:a 16-year-old girl complained of recurrent upper abdominal pain for 4 months.In February 2012，she presented with severe and persistent upper abdominal pain under no obvious precipitating causes and was treated according to the diagnosis of acute pancreatitis in the local hospital.In April 2012，the patient was admitted to Xijing Hospital because of a recurrence of pain concurrently with abdominal distention.CT suggested a pancreatic pseudocyst（Fig.13.13），so ERCP+EPT+naso-pancreatic drainage was performed to drain some brown fluid and decrease the volume of the pseudocyst.Then，another ERCP was carried out to insert the pancreatic duct stent but it failed.Therefore，the patient was admitted to our department for further management.
Physical examination:no significant signs.
Laboratory parameters: total bilirubin 27.9 µmol/L，direct bilirubin 12.1 µmol/L，normal ranges of blood lipid and HbAlc，negative results of CEA，CA19-9 and IgG4.
CT:pancreatic duct dilatation，multiple lowdensity shadows in the pancreatic head and tail suggestive of pancreatic pseudocysts up to 7 cm in diameter，cholestasis（Fig.13.13）.
MRCP:mild atrophy of pancreas，main pancreatic duct dilatation，and multiple filling defects in the pancreas（Fig.13.14）.(https://www.daowen.com)
Diagnosis:adolescent chronic pancreatitis with radiolucent stones.
Fig.13.14 MRCP revealed mild atrophy of pancreas，main pancreatic duct dilatation，and multiple filling defects in the pancreas
Treatment process:ERCP+minor papilla papillotomy+naso-pancreatic drainage was performed on 20 June（Fig.13.15），followed by ESWL on 21 June and 25 June respectively.Then，the patient underwent ERCP+bougienage of the accessory pancreatic duct+accessory pancreatic duct clearance+stent placement on 27 June（Figs.13.16 and 13.17）and recovered well afterwards.