Autoimmune pancreatitis (AIP) is an inflammatory condition of the pancreas, commonly characterized by elevated levels of immunoglobulin G (IgG) 4. Diagnosis of this condition can be challenging in patients with risk factors for other pancreatitis etiologies and requires a comprehensive approach utilizing clinical, radiologic, and laboratory findings. Here, we present a case of an individual with a history of multiple prior hospitalizations for alcoholic pancreatitis, who presented with symptoms of abdominal pain, nausea, and vomiting. Computed tomography (CT) imaging revealed intra-abdominal abscesses and findings consistent with pancreatitis. Further laboratory results revealed elevated lipase and IgG4 levels, indicating AIP as the underlying cause. This case highlights the importance of considering AIP as a differential diagnosis in individuals presenting with pancreatic disease.

We read with interest the recent article by Mr Al-Qattan, ''Type 5 Avulsion of the Insertion of the Flexor Digitorum Profundus Tendon'' (Journal of Hand Surgery 2001, 26B: 5: 427-431). This is a useful addition to the earlier classification by Stamos and Leddy (2000). We too have found the need for the description of an additional type of closed avulsion injury of the insertion of the flexor digitorum profundus tendon (Type 5a and 5b).Along the same lines, we propose the inclusion of a further subtype. We recently treated a patient with a closed avulsion of the insertion of flexor digitorum profundus involving his right ring finger. The radiograph suggested an injury similar to a Type 5b injury.However, the fracture, while intraarticular, did not extend to the dorsal cortex (Fig 1). Also, on exploration, the tendon had avulsed from the large bony fragment and had retracted under the A2 pulley. This was treated with the standard pull out suture technique, tying the knot on to a button over the dorsum of the distal phalanx. This pattern of injury does not fit within either Leddy's or Al-Qattan's description. It appears from Al-Qattan's description of this subtype that the tendon remains attached to the avulsed bony fragment without proximal retraction. The retrieval and reattachment of the tendon added to the complexity of this injury. We would suggest that this pattern could be described as a ''Type 5c'' injury.

No abstract