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Fluctuating serum amylase levels in a patient with pancreatic ascites.

Gross calcification of the pancreatic head in adolescence is a rare condition which raises the possibility of hereditary chronic pancreatitis (HCP) even in the absence of a family history [1]. HCP leads to premature autocatalytic activation of trypsinogen to trypsin. This results in imbalance between intra-pancreatic proteases and their inhibitors, progressing to exocrine and endocrine pancreatic failure with 35%-54% lifetime risk of pancreatic cancer [1,2]. Spontaneous pancreatic ascites usually occurs following pancreatic duct disruption. About 50% of these patients can have leaking pancreatic pseudocysts which causes significant morbidity and mortality [3, 4].