Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report
Chronic pancreatitis in toddlers presents typically by epigastric pain with radiation to the back, steatorrhea, or chronic weight loss despite adequate nutrition, nausea, vomiting, and/or diarrhea. Among adult almost 10% with chronic pancreatitis do not report pain. We report a 21-month-old boy who...
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Cairo University, Faculty of Medicine, Department of Pediatrics
2025-01-01
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| Series: | Pediatric Sciences Journal |
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| Online Access: | https://cupsj.journals.ekb.eg/article_402294_61508b80c961b63d6e4a66477bc20c84.pdf |
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| author | Magd Ahmed Kotb Mohamed Elbarbary Sherif Kaddah Martina Magdy Rania Hamdy Reham Osama Mahmoud Nevian Nabil Noha Adel Yassin Ahmed Nabil Ahmed El Hatw Sayed Khedr |
| author_facet | Magd Ahmed Kotb Mohamed Elbarbary Sherif Kaddah Martina Magdy Rania Hamdy Reham Osama Mahmoud Nevian Nabil Noha Adel Yassin Ahmed Nabil Ahmed El Hatw Sayed Khedr |
| author_sort | Magd Ahmed Kotb |
| collection | DOAJ |
| description | Chronic pancreatitis in toddlers presents typically by epigastric pain with radiation to the back, steatorrhea, or chronic weight loss despite adequate nutrition, nausea, vomiting, and/or diarrhea. Among adult almost 10% with chronic pancreatitis do not report pain. We report a 21-month-old boy who presented by jaundice, clay colored stool, elevated liver enzymes, and hepatomegaly. The mother reported that the child had no complaints otherwise. Hepatitis A virus IgM was positive. He was advised conservative treatment with no response. Two months later he presented by olive green jaundice, pruritus, clay stools, and no other complaints. The coronavirus disease-2019 (COVID-19) anti-spike IgM was positive. Abdominal ultrasound revealed dilatation of intrahepatic biliary radicals, right, left and common hepatic ducts with no abrupt dilation at common bile duct. MRCP and dynamic MRI of pancreas confirmed the findings and detected a bulky head of pancreas with atrophic body and tail compressing the common bile duct. He underwent percutaneous trans hepatic drainage (PTD) with T tube insertion for drainage of the biliary obstruction followed by Frey procedure with coring of pancreatic head to allow biliary drainage. The post-operative course was uneventful and within 3 weeks the jaundice cleared completely. The amylase and lipase dropped after 8 weeks. Chronic fibrosing pancreatitis might be associated with acute hepatitis or COVID-19 and might be painless and get masked by the obstructive jaundice. Chronic pancreatitis presenting by biliary obstruction might be mistaken for prolonged cholestatic hepatitis A infection. Chronic pancreatitis should be excluded in children with suspected prolonged cholestasis. Percutaneous trans hepatic drainage was a necessary step before Frey’s procedure. Chronic pancreatitis in children is amenable to successful surgical intervention. |
| format | Article |
| id | doaj-art-6dc60798adfb4ae58b2d2cf6356fb390 |
| institution | Kabale University |
| issn | 2805-279X 2682-3985 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cairo University, Faculty of Medicine, Department of Pediatrics |
| record_format | Article |
| series | Pediatric Sciences Journal |
| spelling | doaj-art-6dc60798adfb4ae58b2d2cf6356fb3902025-01-07T11:05:41ZengCairo University, Faculty of Medicine, Department of PediatricsPediatric Sciences Journal2805-279X2682-39852025-01-0151606510.21608/CUPSJ.2024.339053.1153Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case ReportMagd Ahmed Kotb 0https://orcid.org/0000-0003-2118-3793Mohamed Elbarbary 1Sherif Kaddah 2Martina Magdy 3Rania Hamdy 4Reham Osama Mahmoud 5Nevian Nabil 6Noha Adel Yassin 7https://orcid.org/0000-0002-9297-4990Ahmed Nabil 8Ahmed El Hatw 9https://orcid.org/0000-0003-3900-9451Sayed Khedr 10Department of Pediatrics, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatric Surgery, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatric Surgery, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatrics, Faculty of Medicine, Cairo University, EgyptDepartment of Radiodiagnosis, Faculty of Medicine, Cairo University, EgyptDepartment of Radiodiagnosis, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatrics, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatrics, Faculty of Medicine, Cairo University, EgyptDepartment of General Surgery, Faculty of Medicine, Cairo University, EgyptDepartment of Pediatrics, Monmouth Medical Center, United States of AmericaDepartment of Pediatric Surgery, Faculty of Medicine, Cairo University, EgyptChronic pancreatitis in toddlers presents typically by epigastric pain with radiation to the back, steatorrhea, or chronic weight loss despite adequate nutrition, nausea, vomiting, and/or diarrhea. Among adult almost 10% with chronic pancreatitis do not report pain. We report a 21-month-old boy who presented by jaundice, clay colored stool, elevated liver enzymes, and hepatomegaly. The mother reported that the child had no complaints otherwise. Hepatitis A virus IgM was positive. He was advised conservative treatment with no response. Two months later he presented by olive green jaundice, pruritus, clay stools, and no other complaints. The coronavirus disease-2019 (COVID-19) anti-spike IgM was positive. Abdominal ultrasound revealed dilatation of intrahepatic biliary radicals, right, left and common hepatic ducts with no abrupt dilation at common bile duct. MRCP and dynamic MRI of pancreas confirmed the findings and detected a bulky head of pancreas with atrophic body and tail compressing the common bile duct. He underwent percutaneous trans hepatic drainage (PTD) with T tube insertion for drainage of the biliary obstruction followed by Frey procedure with coring of pancreatic head to allow biliary drainage. The post-operative course was uneventful and within 3 weeks the jaundice cleared completely. The amylase and lipase dropped after 8 weeks. Chronic fibrosing pancreatitis might be associated with acute hepatitis or COVID-19 and might be painless and get masked by the obstructive jaundice. Chronic pancreatitis presenting by biliary obstruction might be mistaken for prolonged cholestatic hepatitis A infection. Chronic pancreatitis should be excluded in children with suspected prolonged cholestasis. Percutaneous trans hepatic drainage was a necessary step before Frey’s procedure. Chronic pancreatitis in children is amenable to successful surgical intervention.https://cupsj.journals.ekb.eg/article_402294_61508b80c961b63d6e4a66477bc20c84.pdfchronic pancreatitiscovid-19frey procedurepainlesstoddler |
| spellingShingle | Magd Ahmed Kotb Mohamed Elbarbary Sherif Kaddah Martina Magdy Rania Hamdy Reham Osama Mahmoud Nevian Nabil Noha Adel Yassin Ahmed Nabil Ahmed El Hatw Sayed Khedr Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report Pediatric Sciences Journal chronic pancreatitis covid-19 frey procedure painless toddler |
| title | Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report |
| title_full | Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report |
| title_fullStr | Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report |
| title_full_unstemmed | Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report |
| title_short | Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report |
| title_sort | painless silent chronic fibrosing pancreatitis caused complete biliary obstruction in a toddler a case report |
| topic | chronic pancreatitis covid-19 frey procedure painless toddler |
| url | https://cupsj.journals.ekb.eg/article_402294_61508b80c961b63d6e4a66477bc20c84.pdf |
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