Discussion

This case report provides two important clinical lessons. First, extensive calcific chronic pancreatitis may develop within a relatively short period after acute pancreatitis. Second, clinically significant incidental findings outside the urinary tract should be systematically evaluated using KUB radiography and CT performed for urological indications.

Chronic pancreatitis is a progressive inflammatory disease characterized by irreversible changes in pancreatic parenchyma and ductal structures, with pancreatic calcification being one of the most characteristic structural abnormalities [1,2]. Pancreatic calcification is considered an important diagnostic feature of chronic pancreatitis even in the absence of overt clinical symptoms [2]. In the present case, neither CT nor MRCP performed at the time of acute pancreatitis at the age of 31 years demonstrated pancreatic calcifications, whereas extensive diffuse calcifications involving the entire pancreas were identified approximately three years later. This finding suggests that marked calcific changes may develop within a relatively short interval after acute pancreatitis.

Alcohol consumption and cigarette smoking are well-established risk factors for the development and progression of chronic pancreatitis [3,4]. Our patient had a history of smoking and heavy alcohol consumption since his late twenties, with abnormal liver function identified during routine health examinations. In addition, he had consumed approximately 10 glasses of highballs daily during the week preceding the onset of acute pancreatitis. In contrast, hypercalcemia, severe hypertriglyceridemia, and IgG4-related autoimmune pancreatitis were considered unlikely because the serum calcium, triglyceride, and IgG4 concentrations were within normal or near-normal ranges. Therefore, alcohol consumption and smoking were considered the most likely etiological factors contributing to the development of chronic calcific pancreatitis in this patient [1].

In the present case, pancreatic calcifications were incidentally identified on the KUB radiograph, and CT was performed for suspected urolithiasis. Previous reports have emphasized the clinical importance of recognizing incidental findings outside the primary target organs during abdominal imaging examinations [5,6]. Even in urological practice, physicians should systematically evaluate extraurinary structures using KUB radiography and CT to avoid overlooking clinically significant abnormalities. This case emphasizes the importance of a comprehensive image interpretation beyond the urinary tract.

Pancreatic calcification generally develops gradually during the progression of chronic pancreatitis and is typically associated with longstanding disease. Therefore, the development of extensive diffuse pancreatic calcification within approximately three years after an episode of acute pancreatitis in our patient appears rapid compared with the usual clinical course. Although the exact timing of calcification could not be determined, this case suggests that extensive calcification may develop earlier than generally expected in some patients. Furthermore, pancreatic exocrine function was not formally evaluated because fecal elastase or other exocrine function tests were not performed. Nutritional status was also not formally assessed. In addition, no evidence of overt endocrine dysfunction was identified based on the normal HbA1c level at the time of presentation. Therefore, subclinical pancreatic functional impairment could not be completely excluded.

This case has some limitations. First, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography, genetic testing, and evaluation for hereditary pancreatitis or pancreatic divisum were not performed, precluding the exclusion of these etiologies. Second, pancreatic exocrine function and nutritional status were not formally evaluated. Finally, because this is a single case report, a causal relationship between alcohol consumption, smoking, and the rapid development of pancreatic calcification cannot be established.