A 47-Year-Old Man With a History of Alcohol-Induced Chronic Pancreatitis

Juan Carlos Munoz, MD; William J. Salyers, Jr, MD, MPH

Disclosures

May 11, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 47-year-old man with a history of alcohol-induced chronic pancreatitis presents to the emergency department (ED) complaining of a constellation of symptoms, including lightheadedness, fatigue, vague abdominal discomfort, and profuse hematochezia. The patient states that he has been intermittently having loose, "dark-colored" stools over the past 2 weeks. He was previously discharged from the hospital 4 weeks ago following management of a communicating pancreatic pseudocyst, with pancreatic duct stent placement via endoscopic retrograde cholangiopancreatography (ERCP) and CT-guided percutaneous drainage of the pseudocyst.

His medical history is significant only for chronic pancreatitis complicated by pseudocyst formation. He admits to prior heavy alcohol abuse but also reports abstinence for the past 4 years. The patient's medications at the time of admission include acetaminophen/hydrocodone, metoclopramide, pancrelipase, lansoprazole, promethazine, and octreotide 100 mcg subcutaneously three times per day. He denies any recent nonsteroidal anti-inflammatory drug use.

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