Tropical calcific pancreatitis

Tropical calcific pancreatitis is a special type of chronic pancreatitis th at has features quite different from those of alcoholic pancreatitis and is seen almost exclusively in tropical countries. It is characterized by recu rrent severe pain in the abdomen, insulin-requiring but ketosis-resistant d iabetes and large pancreatic calculi in malnourished male adolescents. The clinical course of tropical calcific pancreatitis is protracted with malnut rition, recurrent infections and poorly controlled diabetes. Pancreatic can cer may complicate the natural course in up to 10% of cases. However, in th e community a much milder form of the disease occurs with a female preponde rance and a prevalence of 0.13% or one in 793. Malnutrition with deficiency of proteins and micronutrients with antioxidant properties and food-based toxins, such as cassava, which contain cyanogenic glycosides have been susp ected as possible aetiological factors. Impaired immune response, a presume d infection (possibly viral) and genetic susceptibility are some of the oth er factors suspected in the aetiopathogenesis of this disease. Besides cont rolling diabetes with insulin, relief from pain is obtained by the administ ration of analgesics and pancreatic enzymes and, in severe cases, by perfor ming endoscopic or surgical decompression of dilated pancreatic ducts with removal of pancreatic calculi.