S3350 A Smoked-Out Pancreas - An Unusual Case of Acute Pancreatitis

Abstract

INTRODUCTION: Acute pancreatitis is a significant cause of morbidity and mortality worldwide. It typically results from alcohol use and gallstones; however, a significant number of cases are classified as idiopathic. With the increasing use of Cannabis, acute pancreatitis has been infrequently reported as an adverse effect of its use. CASE DESCRIPTION/METHODS: A 34-year-old male presented to the Emergency room with severe epigastric pain for 3 days. He described the pain as sharp, radiating to the back and worse on lying down. He denied any weight loss, jaundice, fever, pruritus, constipation, diarrhea, or chest pain. His social history was negative for significant alcohol or tobacco use. However, he admitted to cannabis use for several years and had smoked heavily for a few days before the onset of symptoms. He had no significant past medical history and was not on any prescribed or over the counter medications. On physical examination, he was in painful distress. The abdominal examination was significant for marked epigastric tenderness without distension. Bowel sounds were present and normoactive. Laboratory workup showed an elevated serum lipase of 4000 U/L, calcium 9.4 mg/dl, triglyceride 124mg/dl, and aminotransaminases were within normal ranges. The abdominal sonogram was unremarkable for gallstone or any biliary abnormalities. Urine toxicology was positive for only Tetrahydrocannabinol (THC). Computerized tomography of the abdomen and pelvis showed no structural abnormality of the pancreas or ductal dilatation. He was started on intravenous fluid, pain control with morphine, and placed on Nil per oral based on a presumptive diagnosis of acute pancreatitis likely due to the heavy cannabis use in the absence of any other cause of acute pancreatitis. He improved significantly over a couple of days and started on a regular diet and was discharged home after being counseled to avoid cannabis use. DISCUSSION: The exact mechanism of Cannabis induced pancreatitis is poorly understood however, it has been linked to its proinflammatory effect via cannabinoid receptors on the pancreas. Cannabis may be regarded as an overlooked cause of acute pancreatitis typically seen in young males and should be considered during the evaluation of a patient with acute pancreatitis after the common etiologies have been excluded.