3024 Post Whipple's Pancreatitis: Post Procedure Inflammatory Changes Sub-Serving a Diagnostic Challenge

Abstract

INTRODUCTION: Making an accurate diagnosis of pancreatitis in the post-operative setting after a Whipple's procedure can be difficult. Acute pancreatitis inflammatory changes occurring in the peripancreatic area may be indistinguishable from post-operative peripancreatic inflammation hence creating a diagnostic challenge. CASE DESCRIPTION/METHODS: A 54-year-old woman with a past medical history of Type 2 diabetes mellitus, hypothyroidism, and pancreatic head neuroendocrine tumor status post-Whipple's procedure with a residual mild postoperative pancreatic fluid collection which was drained three years ago. She presented with epigastric pain of 5 days duration. She was hemodynamically stable, serum lipase was elevated to 2,752. Abdominal CT done 2 weeks prior to admission for cancer surveillance revealed a stent in the main pancreatic duct. Repeat abdominal CT scan demonstrated the stent and showed acute interstitial pancreatitis. MRI/MRCP done showed mildly ectatic pancreatic duct with a linear structure concerning for a retained stent. She underwent ERCP and the stent could not be visualized with no intervention performed. She was managed with intravenous fluids and analgesics for pancreatitis and subsequently had her diet advanced as tolerated. DISCUSSION: The true incidence of post-Whipple's pancreatitis is unknown, and there are many difficulties in making an accurate diagnosis of pancreatitis. Postoperative findings after pancreaticoduodenectomy can include inflammatory changes and fat stranding, which can make the differentiation between pancreatitis and post-operative changes challenging. Serum levels of amylase and lipase are unreliable in the postoperative period. In severe cases, an abdominal CT would be needed to make the diagnosis of postoperative pancreatitis. Post-Whipple's pancreatitis can have significant prognostic implications, including a higher risk of pancreatic fistula and a higher risk of delayed gastric emptying.