Chronic pancreatitis (CP) is a rare disease in children. Morbidity in the Polish pediatric population is about 20 cases per year. This disease is associated with periods of exacerbation and remission. It leads to irreversible pancreatic gland destruction with fibrosis which can result in impaired exocrine and endocrine dysfunction. The pathogenesis of this disease is multifactorial. The main causes include genetic mutations in PRSS1 (cationic trypsinogen/serine protease 1), CFTR (cystic fibrosis transmembrane conductance regulator), SPINK1 (serine protease inhibitor, Kazal type 1) and CTRC (chymotrypsin C) genes, anatomic anomalies, biliary tract diseases, metabolic disorders. In some patients there are more than one etiological factor. The clinical presentation is usually non-specific, especially in the early stages of the disease. The main symptom is strong abdominal pain, which may be accompanied by vomiting, fever, jaundice, sometimes also bowel obstruction or shock. Often, abdominal pain is the only symptom. The discomfort is aggravated by eating, so patients often refuse food, which leads to weight loss and cachexia. Frequent exacerbations lead to exocrine insufficiency manifesting fatty diarrhea and intestinal absorption disorders.

Diagnosis of CP is based on studies of pancreas structure and function. Imaging studies such as ultrasound, computer tomography (CT scans), magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP) are most reliable in diagnosing CP. ERCP provides the most accurate visualization of the pancreatic ductal system and has been regarded as the criterion standard for diagnosing chronic pancreatitis. Laboratory tests are only a supplement to diagnostic approach. In the remission periods the activity of amylase and lipase is normal. Molecular studies on the mutation of genes predisposing to pancreatitis (CFTR, PRSS1, SPINK1, CTRC, CPA1) are also useful, especially in patients with suspicion of familial pancreatitis.

Chronic pancreatitis is an irreversible process. Treatment consists of nutrition education – high energy and protein diet. In addition, supplement pancreatic enzymes, fat soluble vitamins and trace elements should be provided. Whenever exacerbations are very frequent and pain is present, partial, subtotal or complete pancreas resection is performed. CP significantly increases the risk of developing pancreatic cancer (1).

14.5-year-old boy with suspicion of chronic pancreatitis was admitted to the Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute for further investigation. Previously, he was hospitalized 5 times in a local hospital due to acute pancreatitis. The first episode occurred after an abdominal injury. High amylase activity was demonstrated in laboratory tests performed at that time. Abdominal ultrasound (US scan) describes heterogeneous of pancreas and enlarged of pancreatic duct. The boy had a burdened family history. His father suffered from chronic pancreatitis and his paternal grandfather had one episode of acute pancreatitis.