Atypical Presentation of Acute Pancreatitis in a Man with Pancreatic Insufficiency and Cystic Fibrosis: A Case Report

Malcolm Turner; Hugh Jackson; Robin Harle; Rob Bohmer; David W Reid

Disclosures

J Med Case Reports. 2010;4(298) 

In This Article

Discussion

Although chronic pancreatitis is common in cystic fibrosis, acute pancreatitis is rare and usually occurs in young patients who are pancreatically sufficient.[1,2] We are unaware of any previous reports of acute pancreatitis occurring in an older adult with pancreatic insufficiency and cystic fibrosis but in the setting of normal amylase and lipase. The few reports available concerning acute pancreatitis in patients with pancreatic insufficiency concern children or young adults and always with raised amylase and lipase blood levels.[1,3,4]

In our patient, acute pancreatitis was possibly related to his abnormal pancreatic duct anatomy and the chemical insult of bile constituents causing direct damage to his pancreatic tissue, which was then followed by a local inflammatory response. Despite these proposed mechanisms there was no classical biochemical evidence of pancreatic injury, although imaging confirmed a typical inflammatory mass and gross edema of the pancreas. Clinical improvement was relatively rapid following biliary stenting and the introduction of ursodeoxycholic acid. A repeat CT scan demonstrated a complete resolution of the previous inflammatory mass.

When all other diagnoses have been excluded, the poor diagnostic sensitivity of amylase and lipase in both blood and urine samples have to be considered in older patients with cystic fibrosis who present with abdominal pain.

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