At around 7
am today, there was a 11 year old girl who was brought into emergency at NJH.
She has
been having severe abdominal pain since the last 3 days. She was writhing in
pain. Very typical of how patients with ureteric colic do.
NK had been
having similar complaints since the last 5 years. It occurs once every 4-5
months. Elsewhere, she had been diagnosed to have chronic pancreatitis. During
one of such episodes someone had also done an appendicectomy on her. She also had a CT Scan of the abdomen taken elsewhere which appears normal.
We have her given her non-steroidal analgesics and anti-spasmodics which seemed not to have any impact on her.
The
investigations are as follows –
Hemoglobin:
7.6 gm%
Total
Counts: 14,900/cu mm
Differential
Counts: P83%, E3% L17% Metamyelocytes 2%
ESR: 90
mm/1st hour
Platelets:
178,000/cu mm
Peripheral
Smear:
RBCs: Moderate anemia, Hypochromia +++;
Anisocytosis +++; Microcytosis: +++; Poikilocytosis ++; Few ovalocytes; Tear
drop cells seen
WBCs: Total count – mild leucocytosis;
neutrophilia, toxic granulations+
Platelet: Adequate
Serum
Creatinine: 0.76 mg%
SGPT: 33.5
IU/ml
Urine
Albumin: 1+
Urine
Microscopy: Epithelial cells: 4-5; Pus cells: 1+; RBCs: 1+; Bacteria seen.
Ultrasound
Abdomen: Pancreas with heterogenous echoes and peripancreatic collection. All
other organs were within normal limits. There was no evidence of any gall
bladder or renal calculi.
As per our
instructions, the parents arranged for one pint of blood.
I look
forward to further suggestions. We’ve already suggested that they move ahead to
a paediatric specialist hospital in Ranchi. However, considering into fact that
they have already been evaluated at multiple speciality hospitals primarily in
Patna and Banaras, they are not much interested. They have invested quite a
heavy amount of money in her treatment, going to the extent of selling their
property and land.
It seemed
to me that they do not have any more funds to go further.
I write
this in Acute Care. She’s sleeping very peacefully. Over the day, we’ve found
out that she responds very well to opioid analgesics rather than to
Non-steroidal analgesics.
And of
course, we would value prayers.
it looks like a straight forward case of recurrent acute pancreatitis.. because of typical history, heterogenous echotexture of pancreas and peripancreatic collection..
ReplyDeletethere may be a component of chronic pancreatitis also,despite previous ct being normal, because ct is not the ideal modality for CP..
get serum amylase,lipase levels and CECT abdomen to strengthen the diagnosis
at present, its only conservative management..give as much feed as tolerated and supplement with iv fluids,analgesics
for anemia, u can deworm her with albendazole and start hematinics
for etiology of pancreatitis at this age, work up for hyperparathyroidism(Ca,PTHlevels), pancreas divisum (MRCP),gallstones...
She might suffer from talasemia. It is a rare form of hematologic hereditary disease. It can cause abdominal abnormalities as well.
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