Cases Of Acute Pancreatitis Research Articles

A Case of Severe Acute Pancreatitis Caused by Afferent Loop Syndrome after Gastrectomy with Billroth-II Reconstruction

A Case of Severe Acute Pancreatitis Caused by Afferent Loop Syndrome after Gastrectomy with Billroth-II Reconstruction

Case of COVID-19 and Acute Pancreatitis: A Case Report

Background: Respiratory symptoms, including cough, shortness of breath, and fever, have been reported to be the most common symptoms of Coronavirus disease (COVID-19). However, extra respiratory symptoms, such as gastrointestinal manifestations, have also been reported. Case Presentation: In our paper, we report a case of a 32-year-old African female patient with no previous medical history who presented to the emergency department with altered mental status for one day. The patient had a history of fever, epigastric pain, decreased oral intake, vomiting, and diarrhea. Initial laboratory findings revealed elevated blood glucose, amylase, lipase, blood urea nitrogen, and creatinine levels. Urine ketones were also positive, and blood gases demonstrated severe metabolic acidosis. The patient was admitted to the intensive care unit as a case of diabetic ketoacidosis, acute kidney injury and acute pancreatitis that was later confirmed by computed tomography imaging, where it revealed bilateral renal vein thrombosis with left kidney infarction. Additionally, reverse transcriptasepolymerase chain reaction (RT‒PCR) confirmed COVID-19. The patient improved significantly following conservative management and anticoagulation and was discharged home. Conclusion: Our case demonstrates the importance of considering COVID-19 as a possible cause of acute pancreatitis and that acute kidney infarctions should be part of the differential diagnosis of acute kidney injury in patients who are COVID-19 positive.

A Case of Tamoxifen-induced Acute Pancreatitis after Breast Cancer Surgery

症例は52歳の女性．既往歴に高脂血症を有していた．45歳時に左乳癌に対して，左乳房部分切除術，腋窩リンパ節郭清を施行し，術後薬物療法としてタモキシフェン（TAM 20mg/日）を内服していた．術後7年3カ月（TAM内服開始より6年7カ月）経過した時点で，腹痛・嘔吐を主訴に当院救急外来を受診した．血液検査で，炎症反応上昇とトリグリセリド（TG）2,670mg/dLと著明な上昇を認めた．CTで膵腫大，膵周囲の脂肪織濃度上昇を認め，高TG血症に伴う急性膵炎の診断で入院となった．後方視的に確認すると，TAM開始後より，血清TGは上昇傾向であった．膵炎発症を契機にTAMは中止し，血清TGはTAM開始前と同等にまで改善した．過去の報告によると，TAMによる急性膵炎は内服開始から1年以内に起こることが多いが，本症例のように内服開始から長期経過していても発症することがあり，注意が必要である．

Outcome of Laparoscopic Cholecystectomy in Acute Pancreatitis Secondary to Gallstones: A Prospective Observational Study from Pakistan

Background: Acute gallstone pancreatitis is quite common throughout the globe. Objective: To assess the outcome of laparoscopic cholecystectomy in patients with acute pancreatitis secondary to gallstone. Methods: A prospective observational study was conducted at the Department of Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan between July 2020 to June 2021. All patients who were diagnosed with gallstones pancreatitis were eligible to take part in the study. Other causes of acute pancreatitis like drugs, hyperlipidemia, endoscopic retrograde cholangiopancreatography (ERCP), postoperative and idiopathic were excluded from the study. Patients were offered laparoscopic cholecystectomy. Early laparoscopic cholecystectomy was considered for patients operated between the time of the attack to within 10 days. Operative and postoperative parameters like the mean operative time, the number of ports, mean hospital stay, placement of a drain, and postoperative complications were recorded and analyzed. Results: A total of 383 patients were evaluated with a median age of 47 (36-58) years. 41 (18.5%) patients had difficult dissection. The median operative time was 47 (38-54) minutes while the median hospital stay was 7 (4-10) days. Sixty patients had drain placement. Only minor complications were seen in 20 (9%) patients. Furthermore, the majority of the patients in the gallbladder group i.e. 96.53% had complete recovery while the mortality rate was also very low i.e. 0.46%. Conclusion: Laparoscopic cholecystectomy can be safely performed in selected cases of acute gallstones pancreatitis to prevent further attacks and other consequences of delayed treatment.

A clinical case of acute severe pancreatitis complicated by purulent melting of the duodenal wall

A clinical case of acute severe pancreatitis complicated by purulent melting of the duodenal wall

THE OCCURRENCE OF ACUTE PANCREATITIS AFTER IODINE 131 TREATMENT OF HYPERTHYROIDISM.

Acute pancreatitis is a common and potentially fatal gastrointestinal disease. We report a case of acute pancreatitis induced by iodine-131 therapy for hyperthyroidism. Iodine 131 is distributed through the blood, so it can accumulate and damage normal tissues in other parts of the body that are involved in thyroid hormone metabolis.

A Case of Acute Pancreatitis Associated with Empagliflozin

A Case of Acute Pancreatitis Associated with Empagliflozin

COVID-19-Induced acute pancreatitis – A case series

The present pandemic of the COVID-19 virus has caused enormous morbidity and mortality to humankind. Acute pancreatitis (AP) in otherwise healthy patients infected with the COVID-19 virus has been reported only as case reports and series. We report a series of three cases of AP including one adolescent with necrotizing pancreatitis due to COVID-19 infection, out of total 4117 COVID-19 admission (0.07%) in our hospital till February 8, 2022. Detailed investigations for etiological diagnosis of AP were within normal limits thus, the causation was attributed to COVID-19 viral infection as causative agent. One child succumbed to the illness as he also manifested with features of multisystem inflammatory syndrome and had progressive multi-organ dysfunction despite aggressive management. Further studies are required before a clear mechanism of causation due to the COVID-19 virus is proven in AP.

Left Gastric Artery Pseudoaneurysm within a Pancreatic Pseudocyst: A Case Report

Left gastric artery Pseudoaneurysm (PSA) is a rare vascular complication of Acute Pancreatitis (AP), resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst. The splenic artery is the commonest artery involved, followed by the gastroduodenal artery and pancreaticoduodenal arteries. The occurrence of left gastric artery PSA within a Pancreatic Pseudocyst as sequelae of AP is rare but a significant life-threatening complication. Only a few cases have been reported on left gastric PSA causing haemorrhagic pseudocyst. The authors report a case of AP in a 57-year-old male with history of significant alcohol consumption who presented with pain in abdomen of pancreatic origin. On evaluation, he had a pseudocyst in the pancreatic head. After transpapillary drainage of the pseudocyst, it started draining bloody contents. An abdominal computed tomography was obtained, which showed a small left gastric artery PSA. The patient underwent successful angiographic coil embolisation of the PSA.

Analysis of the clinical characteristics of olanzapine-induced acute pancreatitis.

Numerous case reports of acute pancreatitis (AP) induced by olanzapine have been published. Little is, however, known about the clinical features of olanzapine-induced AP. The aim of the study was to explore the clinical characteristics of olanzapine-induced AP. We collected literature on AP cases induced by olanzapine from 1996 to April 2021 for retrospective analysis in Chinese and English. The median time to onset of olanzapine-induced acute pancreatic symptoms was 12 (range = 0.86–216) weeks in 25 patients. The clinical features of AP range from asymptomatic elevation of blood amylase/lipase levels to digestive system symptoms (abdominal pain, vomiting, and nausea) and even death in a small number of patients. Laboratory tests showed varying degrees of elevated serum amylase and lipase levels, along with high blood sugar and high triglyceride levels in some patients. Computed tomography showed acute edematous pancreatitis, acute hemorrhagic pancreatitis, and acute necrotizing pancreatitis in the patients. The patients’ symptoms were completely relieved and high triglyceride levels gradually returned to normal levels after olanzapine was stopped. Some patients with hyperglycemia still needed hypoglycemic therapy. AP is a rare adverse effect of olanzapine. Clinicians should be aware of such complications and monitor pancreatin.

A Case Report: A Case Of Acute Pancreatitis Due To External Compression Of Diffuse Large B-CELL Lymphoma Mass To The Pancreas

Acute pancreatitis is a condition that can affect patients to varying degrees of severity and cause significant morbidity and mortality. Gallstones and alcohol are the most common causes of acute pancreatitis in our country and around the world. However, there are many different etiologies that may lead to acute pancreatitis. In this article, we present an 86-year-old male patient who was admitted with epigastric abdominal pain, hospitalized with the diagnosis of acute pancreatitis and acute renal failure and finally diagnosed with diffuse large B-cell lymphoma by taking biopsy from a mass that was detected in imaging. Malignancies should be considered in the etiology of acute pancreatitis in patients with advanced age. Keywords: Acute Pancreatitis, Malignancy, Diffuse Large B Cell Lymphoma, Advanced Age

P-P16 Management of acute pancreatitis in a busy district general hospital

Abstract Background Pancreatitis is a common surgical presentation and can be life threatening, with complications such as acute respiratory distress syndrome and necrosis occurring. Due to high hospital incidence, it is important to ensure patients are managed appropriately using available guidelines. This audit aims to assess the management of acute pancreatitis in a busy district general hospital and identify areas for improvement to better patient safety. Methods Only cases of acute pancreatitis were used in this audit. Case notes for the period between October and December 2020 were collected respectively. A data collection proforma was created using guidelines from the British society of gastroenterology for the management of acute pancreatitis. Data was then analysed using Excel. Results 23% of cases had documented scoring, with Glasgow-Imrie the only scoring tool used. 41% had documented oxygen saturation. 33% had been reviewed by alcohol liaison team for pancreatitis secondary to high alcohol consumption. No patients were given the guideline’s recommended rate of fluid resuscitation (5-10ml/kg/hr). All patients had amylase/lipase in their blood profile. 80% of patients had antiemetics prescribed should they require them, whilst 95% of patients had opioids prescribed for analgesia. 50% of patients were given antibiotics despite them not being indicated. 18% were kept nil by mouth (NBM) whilst having abdominal pain. Conclusions Our results suggest that guidelines for acute pancreatitis are not adequately adhered to. Many aspects of the guidance were not followed including documentation of oxygen saturation, antibiotic use, IV fluid resuscitation and alcohol liaison review for patients who required review. We have developed a proforma to use for the management of acute pancreatitis to ensure that cases are managed in accordance with evidence-based literature and to make the management of these cases easier. We will reaudit to analyse the effects of our intervention and determine whether there has been an improvement in the management of acute pancreatitis.

Harmless Acute Pancreatitis Negative among Cases of Acute Pancreatitis in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre. A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated. Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval). The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar toother studies.

Clinical outcomes in acute pancreatitis with relative bradycardia at fever onset.

While some acute pancreatitis (AP) patents with fever do not exhibit a corresponding increase in heart rate, the clinical significance of this phenomenon has not been studied. We investigated the clinical relevance of relative bradycardia (RB) in febrile AP.A retrospective electronic chart review was conducted on consecutive patients admitted for AP at a tertiary referral center in Japan from January 1, 2010, to May 31, 2018. Presence of RB was determined at the first instance of fever, based on formulas used in previous studies.Fever at or during admission was observed in 115 patients, of which 33% had RB. Fever was observed at presentation in 48% and within 48 hours in 94% of cases. Etiologies were alcoholic in 48% and gallstones in 17% of cases. RB patients were older (median age: 62 vs 51 years, P = .028) but had shorter median postfever lengths of stay (8 vs 12 days, P = .003), lower median Ranson scores (1 vs 2, P < .001), and were less likely to develop delirium (11% vs 38%, P = .002). Nineteen of 21 severe AP cases based on the Ranson score were nonbradycardia (P = .011). RB was also associated with lower white blood cell count, C-reactive protein, and lactate levels. On computed tomography, necrosis (P = .028) and moderate or severe pancreatitis (P = .041) were less frequently observed in patients with RB. There was a significant inverse correlation between RB and the Ranson score (−.305, P = .001). While RB was an independent predictors of postfever length of stay (LOS) in multiple regression analysis when the Ranson score was excluded (P = .010), it ceased to be significant when the Ranson score was included (P = .141).AP patients with RB at fever onset had milder disease and shorter LOS compared to those with higher heart rates at fever onset. RB may be useful as a simple, early predictor of shorter LOS before the Ranson score can be calculated.

Acute pancreatitis caused by methimazole/carbimazole assumption: a case-series.

The World Health Organization (WHO) has listed 525 different drugs, that can lead to acute pancreatitis cases, as a medication side-effect. Among them, methimazole (MMI also known as thiamazole, the active form of carbimazole [CBZ]) was included. We reported case reports of patients with overall features compatible with acute pancreatitis episodes following and presumably triggered by the exposure to MMI and its prodrug CBZ. A systematic search was performed on MEDLINE (PubMed). We included case reports of patients with overall features compatible with acute pancreatitis episodes following and presumably triggered by the exposure to MMI and its prodrug CBZ Data extraction and analysis were undertaken in duplicate. We identified 7 case reports. Most patients were female, and one patient was male. Mean age at baseline ranged from 18 to 80 years old. The average time, that elapses between the initiation of the therapy with MMI/CBZ and the onset of typical clinical signs and symptoms pathognomonic of acute pancreatitis, was 2-3 weeks. Based on the data derived from these case reports, it could be considered the possibility of a potential association between MMI/CBZ exposure. Evidence is, however, limited and requires more studies of high quality to confirm this association.

English

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

EP.WE.351Changes in social behaviour during the COVID-19 pandemic and consequences on hospital admissions from acute alcoholic related pancreatitis

BackgroundShifts in social behaviours as a consequence of the COVID-19 pandemic may make people more prone to alcohol use as a coping mechanism. This study aims to investigate whether there was an impact on acute alcohol-related pancreatitis cases given potential changes in alcohol consumption during the first COVID-19 lockdown period in the United Kingdom. It considers the time period since social establishments re-opened in July 2020, to evaluate whether increase alcoholic pancreatitis cases, as a proxy for altered drinking habits, persisted.MethodsAll codes relating to pancreatitis were used to identify cases between March to September (2016 to 2020). Inclusion criteria: acute alcohol-related pancreatitis only. These cases were screened by a group of independent medical juniors and analysed using Excel.ResultsA total of 1905 patients with pancreatitis were identified in the initial search, of which 136 were admitted with acute alcoholic pancreatitis. There was an increase in absolute number of new cases in 2020 compared to previous years (27 compared to a mean of 16 in the previous 4 years). When shops and pubs reopened, cases reduced by 37.5%.ConclusionThis study highlights the issue of increased admission with acute pancreatitis relating to alcohol in the COVID-19 lock down period. During which, this group of patients are likely socially isolated with a lack of support. This calls for an increase in community support for such patients with emphasis on admission avoidance. This is especially important in an era when there is increased hospital admission due to COVID-19.

Acute pancreatitis in a COVID-19 patient in Brazil: a case report

BackgroundThe consequences of the coronavirus disease 2019 pandemic have already exceeded 10 million infected and more than 560,000 deaths worldwide since its inception. Currently, it is known that the disease affects mainly the respiratory system; however, recent studies have shown an increase in the number of patients with manifestations in other systems, including gastrointestinal manifestations. There is a lack of literature regarding the development of acute pancreatitis as a complication of coronavirus disease 2019.Case reportWe report a case of acute pancreatitis in a white male patient with coronavirus disease 2019. A 35-year-old man (body mass index 31.5) had acute epigastric pain radiating to his back, dyspnea, nausea, and vomiting for 2 days. The patient was diagnosed with severe acute pancreatitis (AP)-APACHE II: 5, SOFA: 3, Marshall: 0; then he was transferred from ED to the semi-intensive care unit. He tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription-polymerase chain reaction, and his chest computed tomography findings were compatible with coronavirus disease 2019. Treatment was based on bowel rest, fluid resuscitation, analgesia, and empiric antibiotic therapy. At day 12, with resolution of abdominal pain and improvement of the respiratory condition, the patient was discharged.ConclusionSince there is still limited evidence of pancreatic involvement in severe acute respiratory syndrome coronavirus 2 infection, no definite conclusion can be made. Given the lack of other etiology, we consider the possibility that the patient’s acute pancreatitis could be secondary to coronavirus disease 2019 infection, and we suggest investigation of pancreas-specific plasma amylase in patients with coronavirus disease 2019 and abdominal pain.

Genetic Variation in ABCC4 and CFTR and Acute Pancreatitis during Treatment of Pediatric Acute Lymphoblastic Leukemia.

Background: Acute pancreatitis (AP) is a serious, mechanistically not entirely resolved side effect of L-asparaginase-containing treatment for acute lymphoblastic leukemia (ALL). To find new candidate variations for AP, we conducted a genome-wide association study (GWAS). Methods: In all, 1,004,623 single-nucleotide variants (SNVs) were analyzed in 51 pediatric ALL patients with AP (cases) and 1388 patients without AP (controls). Replication used independent patients. Results: The top-ranked SNV (rs4148513) was located within the ABCC4 gene (odds ratio (OR) 84.1; p = 1.04 × 10−14). Independent replication of our 20 top SNVs was not supportive of initial results, partly because rare variants were neither present in cases nor present in controls. However, results of combined analysis (GWAS and replication cohorts) remained significant (e.g., rs4148513; OR = 47.2; p = 7.31 × 10−9). Subsequently, we sequenced the entire ABCC4 gene and its close relative, the cystic fibrosis associated CFTR gene, a strong AP candidate gene, in 48 cases and 47 controls. Six AP-associated variants in ABCC4 and one variant in CFTR were detected. Replication confirmed the six ABCC4 variants but not the CFTR variant. Conclusions: Genetic variation within the ABCC4 gene was associated with AP during the treatment of ALL. No association of AP with CFTR was observed. Larger international studies are necessary to more conclusively assess the risk of rare clinical phenotypes.

S50 Systemic Sclerosis Patients Have a Higher Risk of Developing Acute Pancreatitis: A Nationwide Population-Based Study

Introduction: Systemic sclerosis (SSc) is a rare autoimmune disease characterized by fibroproliferative alterations of the microvasculature leading to fibrosis and loss of function of the skin and internal organs. Gastrointestinal manifestations of SSc are the most commonly encountered complications of the disease affecting nearly 90% of the SSc population. A few cases of acute pancreatitis (AP) in SSc have been described, however, the risk of AP among SSc patients is not known. We sought to investigate the risk and predictors of AP among SSc patients. Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature Of Medicine—Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) who were diagnosed with SSc another cohort of those who developed AP. Logistic regression analysis was performed for AP in 2 groups of patients: those with SSc and those without SSc. Results: Of the 62,720,250 individuals in the database from 2010 to 2019, we identified 32,920 patients with SSc and 366,050 patients with AP, of whom 670 (2%) carried both diagnoses. Statistically significant differences were found in 7 demographic and baseline characteristics: Male sex, alcohol abuse, biliary stones, smoking, hypertriglyceridemia, hypercalcemia and obesity (Table 1). Multivariate logistic regression analysis showed that patients in the SSc group had 3.54 times higher odds (odds ratio 3.54, 95% Confidence Interval 3.28-3.38, P = 0.000) of developing AP. Conclusion: This is the largest individual study investigating prevalence of AP in patients with SSc. The results indicate that SSc patients are at an increased risk of AP even after adjusting for common AP risk factors. Further studies are required to validate these findings as it has important clinical implications among SSc patients.Table 1.: Univariate and Multivariate Logistic Regression Analyses For The Predictors Of Acute Pancreatitis