3038 A Rare Case of Pancreatitis Due to Paraesophageal Hernia

Abstract

INTRODUCTION: Pancreratitis due toWe present a rare case of acute pancreatitis due to a large paraesophageal hernia who presented to the emergency department with chief compliant of epigastric pain and dysphagia. CASE DESCRIPTION/METHODS: A 65-year- old female presented to our emergency department due to progressively worsening epigastric pain. The pain sharp, intermittent and moderate in severity and radiated to her back associated with nausea and vomiting. She denied fever, shortness of breath, or chest pain. A review of systems was otherwise negative. Physical examination including vital signs was unremarkable with the exception of mild epigastric tenderness on palpation. Seven years prior to admission, patient underwent laparoscopic cholecystectomy for gallstones pancreatitis. Laboratory data was unremarkable. Although her serum lipase was within normal limits (114 U/L), her history and physical were concerning for pancreatic pathology. Therefore, CT scan of the abdomen was obtained and demonstrated trace inflammatory fluid around the pancreatic uncinate process, consistent with mild pancreatitis. Additionally, a massive hiatal hernia was noted causing mild atelectasis in the lung bases. The patient was admitted to our facility and was treated for the presumptive diagnosis of recurrent pancreatitis. Of interest, five months prior to this admission, the patient had presented to the ED with similar symptoms. CT imaging at that time had also demonstrated large paraesophageal hernia. She was evaluated by our general surgery service and was deemed not to be a candidate for surgical intervention. Due to the recurrent nature of her symptoms, she subsequently underwent esophagogastroduodenoscopy during which the paraesophageal hernia was identified with a large amount of food and fluid within it. Thusly she was reevaluated by our general surgery team and ultimately underwent reduction of her stomach, paraesophageal hernia repair, and gastrostomy tube insertion. Patient did well post-operatively with no complication. Patient was discharged to rehab 7 days after surgery. DISCUSSION: We believe that the patient's recurrent symptoms were the result of progressive enlargement of the paraesophageal hernia that manifested as a gastric volvulus. There are few cases of pancreatitis due to paraesophageal hernia leading pancreatic herniation1. Serum lipase measurements that are below normal limits can indicate chronic pancreatitis2. Few cases of pancreatitis were reported with low lipase.2