69-Year-Old Woman With Progressive Weakness and Anorexia

According to the International Association of Pancreatology and the American Pancreatic Association, two of three criteria must be met for diagnosing acute pancreatitis: upper abdominal pain; lipase more than 3 times upper limit of normal; and imaging criteria with either computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound.1 She already does not meet two of the above criteria and thus pancreatitis is unlikely to be contributing to her symptoms. [...]she may have gallstones but with lack of pain and nausea/vomiting, it is unlikely she has symptomatic gallstone disease. CT of her abdomen and pelvis was pursued but no diagnostic abnormalities were reported that could explain her anorexia. Because of her continued inability to tolerate oral intake, EGD was performed, which revealed antral deformity with contraction, scarring, and pinhole opening. Total parenteral nutrition could be pursued if nasogastric or nasojejunal feeding were not possible before other management options. Because of the nature of her pin-holesized pyloric channel and malnourishment, fluoroscopy-assisted balloon dilation was used.