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Clinical Crossroads | Clinician's Corner

A 21-Year-Old Man With Chronic Pancreatitis

Mark P. Callery, MD; Steven D. Freedman, MD, PhD
JAMA. 2008;299(13):1588-1594. doi:10.1001/jama.299.9.jrr80001.
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Chronic pancreatitis is a disease for which the diagnosis may be difficult to ascertain and the treatments are limited. Using the case of a 21-year-old man who has had recurrent episodes of epigastric pain since age 10 years and was ultimately diagnosed as having idiopathic pancreatitis complicated by pancreatic duct stones, we discuss the evaluation and treatment of chronic pancreatitis. Diagnosis is based on thorough history taking, physical examination, and carefully selected imaging studies. Etiologies may be structural or nonstructural; genes predisposing to chronic pancreatitis have been identified. An evidence-based approach to treatment is limited by a paucity of randomized controlled trials. We address the patient's concerns regarding chronic pancreatitis, including what he should expect over the next several years, whether endoscopic or surgical therapies should be considered, and whether there are any cures.

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Figure. ERCP-Generated Image of the Bile and Pancreatic Ducts of a Patient Similar to Mr C
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The bile duct appears normal. The pancreatic duct is significantly dilated (approximately 13 mm), irregular, and contains multiple filling defects (arrowheads) consistent with stones. ERCP indicates endoscopic retrograde cholangiopancreatography.

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