Primary sclerosing cholangitis with chronic pancreatitis

History and clinical findings: A 68-year old man with insulin dependent diabetes mellitus was admitted to hospital because of diarrhoea, general weakness and 10 kg weight loss over the preceding 3 months. Biliary tract enzymes were markedly elevated (alkaline phosphatase > 1000 U/I, gamma-glutamyl transferase > 300 U/I). Computed tomography (CT) was suggestive of a space occupying lesion in the head of the pancreas. Investigations: CT confirmed the space-occupying lesion and biopsy revealed chronic fibrosing pancreatitis. Radiology showed the typical picture of primary sclerosing cholangitis (PSC), in addition to inflammatory changes in the pancreatic duct. Treatment and course: Administration of ursodeoxycholic acid and substitution therapy for the exocrine and endocrine pancreatic insufficiency normalised the laboratory values. The patient gained 5 kg and the changes in the biliary tract and pancreatic ducts markedly regressed. Conclusion: PSC is rarely associated with inflammatory pancreatic changes, which cause Severe functional changes. Ursodeoxycholic acid improves both the biochemical changes and the histological lesions of the biliary tract and the pancreatic ducts.