ESPE Abstracts

Introduction: Chronic pancreatitis is defined as recurrent or persistent pancreatitis, which will result in irreversible morphological change in pancreatic structure leading to pancreatic exocrine and endocrine insufficiency. ICCP is a rare condition and only few cases in adults have been reported in Sri Lanka. Prevalence of ICCP is highly variable in Asian and western countries. We present a rare case of FCPD in a 9 a years old boy.

Case presentation: 9 years old boy presented with polyuria, polydipsia and weight loss for one month duration. His fasting blood sugar and HbA1C were 213mg/dL and 11.28% respectively. Urine-ketones were negative and C peptide was 0.36ng/mL(0.7-1.9). Pancreatic autoantibodies were not done. During follow up he developed burning type abdominal pain radiating to back which was worsening with meals. On examination weight was 30kg(25-50thCentile) and height was 99cm(25-50thCentile). He was in pre puberty. His FBC, blood-picture, calcium, liver functions, proteins and CRP were normal. USS followed by Contrast enhanced CT abdomen showed chronic calcific atrophic pancreatitis. He history of trauma, family history of pancreatitis, features of cystic fibrosis or autoimmunity. ESR, P-ANCA and C-ANCA were normal. Although he had endocrine deficiency there was no exocrine pancreatic deficiencies.

Discussion: There are several etiological factors for adult chronic pancreatitis. However, the causes remain trickier in children. ICCP is an infrequent entity with pancreatic stone formation with pancreatic endocrine and exocrine deficiency. Diabetes in chronic pancreatitis is classified as FCPD. Usual presentation is chronic abdominal pain followed by non ketotic hyperglycaemia in the 2nd/3rd decade of life. Unusually, our patient presented with diabetes and later diagnosed with ICCP.

Conclusion: Diabetes in childhood is commonly polygenic immune mediated Type1. However greater degree of suspicious is needed to identify rare occurrence of FCPD which is important in patient follow up and management. USS abdomen is an important investigation to be done in suspected patients.