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Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report

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Last updated: 07 Jan 2025

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Abstract

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.

DOI

10.21608/cupsj.2024.339053.1153

Keywords

Chronic pancreatitis, COVID-19, Frey procedure, painless, toddler

Authors

First Name

Magd

Last Name

Kotb

MiddleName

Ahmed

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

magdkotb@kasralainy.edu.eg

City

-

Orcid

0000-0003-2118-3793

First Name

Mohamed

Last Name

Elbarbary

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt

Email

mohamed.elbarbary@kasralainy.edu.eg

City

-

Orcid

-

First Name

Sherif

Last Name

Kaddah

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt

Email

kaddah@hotmail.com

City

-

Orcid

-

First Name

Martina

Last Name

Magdy

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

martina.magdy@students.kasralainy.edu.eg

City

-

Orcid

-

First Name

Rania

Last Name

Hamdy

MiddleName

-

Affiliation

Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Egypt

Email

rania.hachem@yahoo.com

City

Cairo

Orcid

-

First Name

Reham

Last Name

Osama Mahmoud

MiddleName

-

Affiliation

Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Egypt

Email

reham81_2006@hotmail.com

City

Cairo

Orcid

-

First Name

Nevian

Last Name

Nabil

MiddleName

-

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

neviannabil@yahoo.com

City

-

Orcid

-

First Name

Noha

Last Name

Yassin

MiddleName

Adel

Affiliation

Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt

Email

noha.adel20@yahoo.com

City

-

Orcid

0000-0002-9297-4990

First Name

Ahmed

Last Name

Nabil

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt

Email

ahmednabil@kasralainy.edu.eg

City

-

Orcid

-

First Name

Ahmed

Last Name

El hatw

MiddleName

-

Affiliation

Department of Pediatrics, Monmouth Medical Center, United States of America

Email

ahmedelhatw@gmail.com

City

NewJERSEY

Orcid

0000-0003-3900-9451

First Name

Sayed

Last Name

Khedr

MiddleName

-

Affiliation

Department of Pediatric Surgery, Faculty of Medicine, Cairo University, Egypt

Email

sayed_khedr@kasralainy.edu.eg

City

Cairo

Orcid

-

Volume

5

Article Issue

1

Related Issue

52655

Issue Date

2025-01-01

Receive Date

2024-11-28

Publish Date

2025-01-01

Page Start

60

Page End

65

Print ISSN

2805-279X

Online ISSN

2682-3985

Article File

CUPSJ_Volume 5_Issue 1_Pages 60-65.pdf

PDF . 7.1MB

Link

https://cupsj.journals.ekb.eg/article_402294.html

Detail API

http://journals.ekb.eg?_action=service&article_code=402294

Order

402,294

Type

Case Report

Type Code

1,279

Publication Type

Journal

Publication Title

Pediatric Sciences Journal

Publication Link

https://cupsj.journals.ekb.eg/

MainTitle

Painless Silent Chronic Fibrosing Pancreatitis Caused Complete Biliary Obstruction in a Toddler: A Case Report

Details

Type

Article

Created At

07 Jan 2025