Lakes in pancreas: a tropical malady
This striking ERCP picture of an extreme form of chronic pancreatitis belonged to a 22 year-old man from India who had presented to me with recurrent abdominal pain and insulin requiring diabetes of over 5 years duration. The ERCP picture of this young man enthused me in 1986 to dwell on this disease and hypothesize on its origins. This disease has been labeled as chronic calcific pancreatitis of the tropics. This problem seems to be confined to the tropics and is not related to youthful blunders with alcohol nor to any other known cause of chronic pancreatitis.
The features on ERCP which distinguish it from the other forms of chronic pancreatitis are a hugely dilated pancreatic duct with a smooth outline without serrations; the predominant changes being in the main pancreatic duct. This form of chronic pancreatitis has a 7-9% chance of undergoing malignant transformation. Such region specific protean manifestations of a common disease can be enthralling for the student but a humbling experience for the scientist and the clinician.
Download the slide