Dr AvinashTank, is a super-specialist (MCh) Laparoscopic Gastro-intestinal Surgeon,
Chronic calcifying/calcific pancreatitis (CCP) is a special form of chronic pancreatitis that is associated with pancreatic stones.
This is also known as Tropical calcific pancreatitis (TCP) as it occurs in children and young adults in tropics and has features that distinguish it from alcoholic calcific pancreatitis (ACP) seen in developed countries of the subtropics. In India, it’s very common in southern part but also seen in other northern & western India.
Malnutrition, food toxins, deficiency of micronutrients and recently genetic factors are considered the underlying cause of this disease.
The main symptoms were abdominal pain, diabetes mellitus, weight loss, obstructive jaundice and steatorrhea (oily stool). Abdominal pain may be episodic or unrelenting pain that is not relieved by drugs and warranted therapy. On the other hand, patients may experience pain-free episodes for years due to significant damage to pancreas. Some patients may present as uncontrolled diabetes or stool looks like oily and it float over pot despite flush. Both symptoms suggest that damage to pancreas so extensive it doesn’t sufficient enzymes for digestion of food.
There are no specific blood test. X-ray or Ultrasonography may shows stones in pancreas. CECT pancreas is advised to assess the location of stones and their load and other complications. MRCP is advised if jaundice is also associated.
If untreated for long term, following complications may develop
Low fat diet, simple pain killer and supplementation of pancreatic enzyme is initial treatment. Endoscopic therapy is advised there is a single stone and pancreatic duct is dilated. Surgery is advised when there is multiple stones in pancreas, narrowing of pancreatic duct at multiple level or presence of complications. Surgical approach for calcific chronic pancreatitis includes drainage procedure or resectional procedure. This decision is based upon the extend of pancreatic disease.
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