An 18-Year-Old Woman with Recurrent Pancreatitis

Moderator's Introduction

I am pleased to welcome a distinguished gastroenterologist and therapeutic endoscopist from Rome, Italy, Dr. Guido Costamagna, as discussant for this case.

An 18-year-old white woman was referred for evaluation of four episodes of acute pancreatitis within a 3-month period. She had no obvious risk factors for pancreatitis. In particular, she had no history of gallstones, alcohol abuse, trauma, hyperlipidemia, or hypercalcemia. Her only prescription medication was an oral contraceptive pill. She had been a healthy child and there was no known family history of pancreatitis. The computed tomography (CT) scan performed at another hospital showed a somewhat dilated main pancreatic duct, but the parenchyma looked normal, and there were no fluid collections or cysts related to the pancreas. At endoscopic retrograde cholangiopancreatography (ERCP), the patient's papillary anatomy appeared normal. The cholangiogram was normal. However, the pancreatogram was abnormal. There were a number of filling defects in the main pancreatic duct in the head of the gland. lt proved impossible to advance a guide wire deep into the pancreatic duct at the time of this ERCP, so a needle-knife papillotomy was performed to improve access. A pancreatic stent was placed across the obstructing defects during a second ERCP (Figures [1] [2] ). Some small white fragments were coaxed out through the papilla, but the larger filling defects appeared firmly anchored. Both ERCPs were complicated by postprocedural pancreatitis lasting approximately 1 week.

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