Nicodemus, Nuraini Irma Susanti
OBJECTIVE: Chronic pancreatitis as one of the possible etiologies of chronic recurrent abdominal pain in children is often neglected. The incidence of chronic pancreatitis is estimated to be 0.5 per 100,000 children annually. A number of complicating factors have been identified which include the presence of pancreatic stone and pseudocysts. CASE: A 12-year-old boy presented to our emergency department with acute epigastric pain radiating to his back perceived as sharp episodic pain since 1 day prior to admission. The patient experienced the same complaint repeatedly since 9 months ago following a traumatic injury. The physical examination revealed abdominal tenderness around the left hypochondriac and epigastric regions. Laboratory studies showed increased serum amylase and lipase levels that reached 6 (327) and 3 (176) times higher than the normal limits, respectively; other laboratory parameters were considered normal. Abdominal ultrasound only showed mild dilated pancreatic duct with small pancreatic stone. CT-Abdomen with contrast showed multiple stone and calcification in pancreatic head and body with dilated pancreatic duct. MRCP study showed dilated pancreatic duct, multiple stone in the pancreatic head and body along with multiple peripancreatic pseudocysts. The patient was given low-fat diet, IV fluid therapy, NSAID, antibiotic and underwent surgical intervention with Poestow procedure. The patient showed significant improvent in pain scale as well as the reduction in serum pancreatic enzyme levels (amylase: 79 and lipase: 16). CONCLUSION: Pancreatitis is often neglected as a cause of abdominal pain in children. Chronic pancreatitis should be considered as one of the possible causes of chronic recurrent abdominal pain in children as it necessitates early surgical intervention especially in cases with complication of pancreatic stone.