Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 37: A 12-Year-Old Patient Has A 5-Year History Of Recurrent “Acute Pancreatitis,” Managed Conservatively With Pancreatic Enzymes Supplement. Ct Reveals Mildly Dilated Pancreatic Duct With A Possible Stone In The Head Of The Pancreas. What Else Can I Do? (continued)

Joseph Leung, MD, FRCP, FACP, FASGE, MACG

The patient has had attacks of pancreatitis since a relatively young age and we have to consider different etiological factors instead of the usual common causes of pancreatitis.1 That imaging suspicion of a stone in the pancreatic duct (PD) would suggest underlying chronic pancreatitis secondary to intrinsic pathology in the pancreas, affecting either the secretion or drainage of pancreatic juice. Such conditions include congenital ductal anomalies (eg, pancreas divisum) or cystic fibrosis with predisposition to thick pancreatic secretions and precipitation of calcium carbonate (stones) in…