A 42-Year-Old Man With Persistent Abdominal Pain

Introduction. A 42-year-old man presents to the office describing several weeks duration of abdominal pain. The pain is in the upper abdomen, midline, and is "boring" in nature. Although not constant, he experiences some degree of pain several days a week. Nausea is another feature that accompanies the painful episodes. He denies hematemesis, melena, or jaundice. There has been, however, increased frequency of bowel movements from once daily to three times per day.

Patient history. The patient has been admitted several times for acute pancreatitis in the last 5 years, roughly once per year. He recognizes the nature of the current abdominal pain as similar to those episodes of acute pancreatitis, but not as severe. He is a salesman, frequently traveling, and is a former heavy drinker, although his alcohol consumption has decreased in recent years. He also has a 25+ pack year smoking history.

Physical examination. The patient’s physical examination was generally unremarkable: mucosae are dehydrated and non-icteric, moderate tenderness in the mid-epigastrium with some radiation to the back but no rebound, and his stool is heme negative. The patient’s basic laboratory tests indicate a complete blood count that is within normal range and electrolytes with a fasting blood glucose of 134 mg/dL (normal range, <100 mg/dl).

The presented patient has the onset of chronic pancreatitis. Significant clues for his current abdominal pain include the patient's background history of acute pancreatitis events, the strong history of alcohol and tobacco use, and his diarrhea symptoms. He is a rather classic example, in both demographics and epidemiology, of chronic pancreatitis (annual incidence 5-8/100,000 and prevalence 42-73/100,000).¹

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