IMAGE OF THE WEEK 2013

WEEK 17

CHRONIC PANCREATITIS

Figure 1a: Plain abdominal radiograph showing coarse calcification along the line of the whole pancreas with osteomalacia of the bones. (Click on image to enlarge)	Figure 1b: Plain abdominal radiograph with magnification of the calcified pancreas. (Click on image to enlarge)

Chronic pancreatitis is a condition characterized by repeated pancreatic inflammation leading to progressive pancreatic damage and fibrosis with eventual impairment of both exocrine and endocrine functions of the pancreas.

The most common aetiology in the western societies is alcohol abuse. In Brunei, gallstones are the most common aetiology, although the condition of chronic pancreatitis is uncommon. Acute pancreatitis and chronic pancreatitis are assumed to be different disease processes and most cases of acute pancreatitis do not result in chronic disease.

Chronic pancreatits can be classified into 3 types:

·         Chronic calcifying pancreatitis – associated with alcoholism.

·         Chronic obstructive pancreatitis – periductal fibrosis and ductal dilatation.

·         Chronic inflammatory pancreatitis

Imaging plays an important role in the diagnosis and management of chronic pancreatitis. Plain abdominal radiographs show pancreatic calcification in 25-59% of patients and is pathognomonic of chronic pancreatitis (Figure 1a and b). The coarse calcification occurs along the distribution of the pancreas. There is also associated osteomalacia in the spine, pelvic bones and lower limb long bones secondary to malabsorption. CT is useful in differentiating chronic pancreatitis from pancreatic carcinoma. The use of secretin with MR cholangiopancreatography can be use to demonstrate pancreatic exocrine reserve.

Treatment of uncomplicated chronic pancreatitis is usually symptomatic relief of pain, malabsorption and resulting diabetes. Minimally invasive therapy and surgery are generally reserved for complications such as pseudocysts, abscess and malignancy.

Images contributed by

Dr Ian Bickle, Department of Radiology,RIPAS Hospital

Text contributed by Mr William Chong, Department of Surgery, RIPAS Hospital

All images are copyrighted and property of RIPAS Hospital.