Hyperlipidemic Pancreatitis: Prevalence, Presentation and Outcome

Abstract

Background: This study was done to determine uncommon causes of acute pancreatitis to improve outcome of management. Aim: The aim is to determine the prevalence, clinical presentation, and outcome of hyperlipidemic pancreatitis in a single academic institute. Patients and methods: Records of 81 patients admitted with acute pancreatitis to King Abdulaziz University hospital were looked at retrospectively between June 2010 and Sept 2012. Data were collected which included the demographics, clinical presentation, amylase level on admission, findings of the computed tomography (CT) scan, intensive care (ICU) admission and length of hospital stay. Patients were then categorized into three categories: patients with first attack (group A), those with recurrent attacks (group B) and those with readmission with a second attack from group A (group C). Results: Out of 81 patients, 7 (10%) patients were found to have hyperlipidemic pancreatitis. Age range was 21 - 68 years (mean = 44.5). The male patients were 4 and the females were 3. All patients presented with epigastric pain. Four patients were in group A while 3 patients were in group B and, 3 patients in group C. Group C is the recurrence from group A 3 out of 4 patients. The amylase ranged 170 - 220 IU/L in group A, compared to group B which was 1200 - 2500 IU/L and, group C amylase levels were 1100 - 2000 IU/L. None of the patients in group A were known to have hypertriglyceridemia (HTG), while all in group B and C were known to have HTG. The level of triglyceride (TG) in all the groups was raised ranging from 12.5 - 20.2 mmol/l. Diabetes was present in 3 of group A patients, non in group B and, all of group C in which was not controlled by medications. CT grading (Balthazar Index) was B for groups A and B, while for patients in group C it was C with 30% necrosis. No ICU admission was required for patients in group A and B, while all the patients in C needed ICU admission. Hospital stay was 3 - 5 days for group A, 7 - 10 days for group B and 7 - 12 days for group C. Conclusion: Prevalence of hyperlipidemic pancreatitis was found to be 10%. Patients with first attack presented with mild to moderate attack and a favorable outcome. A second attack was often severe and was associated with necrosis. Patients with a second attack should be closely monitored as they might need an ICU setting.