This was a 42-year-old gentleman , a known case of Insulin dependant Diabetes Mellitus. He was being evaluated by his physician for loss of weight and abdominal pain of a few months duration.

His abdominal ultrasound pictures are given below.

 

 

 

 

 

 

The following pictures show the pancreas.

 

Pancreatic duct is dilated prominently.

 

 

 

Pancreatic duct dilated.- 12.9 mms.

 

 

 

Pancreatic calculi are seen.

 

 

 

 

 

 

 

This patient further underwent Upper G.I. endoscopy , which was normal and later MRI scan , which confirmed the ultrasound findings. He was conservatively managed and is clinically better.

This patient had no history of alcoholism . He does not fit into a classical Tropical Pancreatitis or Fibrocalculous Pancreatic Diabetes.

 Diagnostic criteria for fibro-calculous pancreatic diabetes (FCPD) 
1. Occurrence in a “tropical” country.
2. Diabetes by WHO Study Group [1] criteria.
3. Evidence of chronic pancreatitis: pancreatic calculi on X-ray or at least three of the following:
a) Abnormal pancreatic morphology by sonography
b) Chronic abdominal pain since childhood
c) Steatorrhoea
d) Abnormal pancreatic function test.
4. Absence of other causes of chronic pancreatitis. i.e. alcoholism, hepatobiliary disease or primary hyper parathyroidism

 This patient did not have any abdominal pain until recently .But the other features would probably fit into  the diagnosis.

Click to access fcpd.pdf

Click to access chapter7.pdf

http://emedicine.medscape.com/article/181554-overview#showall