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A patient with bag of pancreatic stones
  1. S Bhoi,
  2. R Kumar,
  3. M Kumar,
  4. V Shukla,
  5. B Sharma,
  6. B B Gupta
  1. Department of Medicine, Dr Ram Manohar Lohia Hospital, New Delhi, India
  1. Correspondence to:
 Dr B B Gupta, D-II/M-2757, Netaji Nager, New Delhi 110023, India;
 dr_bbgupta{at}rediffmail.com

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Answers on p 505.

A 26 year old woman presented with history of recurrent colicky abdominal pain since childhood. There was a history suggestive of steatorrhoea, polyuria, and polydipsia of eight years’ duration. On general examination she had pulse rate of 80 beats/min, blood pressure 124/80 mm Hg, and there was no postural hypotension. Her height was 130 cm, weight 28 kg, body mass index 17 kg/m2, waist circumference (W) 25 cm, hip circumference (H) 27 cm, and her W/H ratio was 0.9. There was pitting pedal oedema and loss of skinfold thickness. Systemic examinations including ophthalmoscopic examination were normal. Investigations revealed normal complete blood count, fasting blood glucose 11.1 mmol/l, postprandial blood glucose 14.2 mmol/l, and glycated haemoglobin was 10%. Her serum protein was 50 g/l and corrected serum calcium as well as lipid profile was normal. There was no evidence of ketonuria or microalbuminuria. A plain radiograph of the abdomen showed radio-opaque shadow at the level of right side of first lumbar vertebra. Contrast enhanced computed tomography of the abdomen was done and was abnormal (fig 1).

Figure 1

Contrast enhanced computed tomography of the abdomen.

QUESTIONS

  1. What is the diagnosis?

  2. What are the radiological features and radiological differential diagnosis?

  3. Why are these patients ketosis resistant?

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