Sunday, September 13, 2009
I have been here for 2 years and have hardly seen a case of pancreatitis the whole time. Why? I am not sure as it is very common in the US. Despite this, in one day last week, I saw 2 cases of pancreatic pseudocyts, which are often a combination of chronic pancreatitis. The first young man presented with hx of abdominal pain on/off for months. I had even seen him about 2 months ago, and said he had a normal ultrasound, and told him to followup, but he didn't. This time, he comes back with a weeks worth of worsening abdominal pain. He was very tender on exam, and his ultrasound this time wasn't so normal. I found a huge pocket of what looked like pus to me, but it didn't quite seem like it was in the liver, I wasn't sure what I was looking at. I talked to Bill and he thought it was outside the liver also, but not sure what it was. Jim told us it was a pseudocyst after doing surgery to drain it. The 2nd pt was a girl of 10 yo, who Bill had seen last week with this abdominal pain and swelling and she too had this large fluid filled something on ultrsound which didn't show up on xray. Jim confirmed her diagnosis when he got an amylase of 720. Without a CT scan, he isn't sure how mature the cyst is, but is ready to do surgery on her, if needed. He doesn't do this kind of surgery that often, so pray for God to give him wisdom and to guide his hands when/if he needs to go in on her.