Final answer:
In treating chronic autoimmune pancreatitis in a patient averse to surgery, optimizing medical therapy with enzyme supplements, pain management, and possibly immunosuppressive agents is important, alongside dietary adjustments and regular monitoring through imaging tests.
Step-by-step explanation:
The most appropriate management for a 66-year-old female with a history of chronic autoimmune pancreatitis, who presents with severe, aching, midabdominal pain radiating to the back, would include addressing the underlying inflammation and providing symptomatic relief. Given that she is not ready to accept a pancreaticojejunostomy, medical therapies should be optimized. These may include pancreatic enzyme supplements to aid in digestion and reduce nutritional deficiencies, analgesics to manage pain, and corticosteroids or other immunosuppressive agents to address autoimmune inflammation. Alterations in diet to low-fat meals can also help to reduce symptoms. It is important to monitor for complications such as pseudocysts or abscesses with imaging tests such as abdominal ultrasound or CT scan.