Serum Lipase Levels Research Articles

Can We Detect Chronic Pancreatitis With Low Serum Pancreatic Enzyme Levels?

The aims of this study were to evaluate whether serum pancreatic enzyme levels could be used to aid screening for chronic pancreatitis (CP). 170 healthy volunteers were screened and prospectively enrolled in the control group. 150 patients who were diagnosed with calcific CP were enrolled in the patient group by retrospective review. Serum amylase and lipase levels were compared between the 2 groups. The mean values ± SD of the control group were compared with those of the patient group for serum amylase level (48.1 ± 13.2 vs 34.8 ± 17.2 U/L, P < 0.001) and serum lipase level (26.4 ± 11.3 vs 16.3 ± 11.2 U/L, P < 0.001). On the receiver operating characteristic curve analysis for amylase level, area under the curve was 0.740 (95% confidence interval), and sensitivity and specificity were 38.7% and 94.1%, respectively, with a cutoff value of 27.5 U/L. On the receiver operating characteristic curve analysis for lipase level, area under the curve was 0.748 (95% confidence interval), and sensitivity and specificity were 33.3% and 95.9%, respectively, with a cutoff value of 10.5 U/L. Our results suggest that low serum pancreatic enzyme levels can be used to aid in detection of CP.

Serum lipase activity and concentration during intravenous infusions of GLP-1 and PYY3-36 and after adlibitum meal ingestion in overweight men.

To examine the effect on serum lipase activity and protein concentration of intravenous infusions of glucagon‐like peptide‐1 (GLP‐1) and peptide YY (PYY 3‐36) and of an ad libitum meal in healthy overweight men. Twenty‐five healthy, male subjects participated in this randomized, double‐blinded, placebo‐controlled 4‐arm crossover study (Body Mass Index (BMI): 29 ± 3 kg/m2, age: 33 ± 9 years). On separate days, the subjects received a 150‐min intravenous infusion of either (1) 0.8 pmol/kg/min PYY 3‐36, (2) 1.0 pmol/kg/min GLP‐1, (3) 1 + 2, or (4) placebo. Samples were collected throughout the infusion and after intake of an ad libitum meal for measurement of serum lipase. Serum lipase levels measured by enzyme‐linked immunosorbent assay (ELISA) following mono‐infusions of GLP‐1 and PYY 3‐36 were comparable to serum lipase levels following placebo (P = 0.054 and P = 0.873, respectively). Following the co‐infusion of GLP‐1 and PYY 3‐36, serum lipase levels measured by ELISA decreased over time compared to placebo (P = 0.012). However, the between‐group difference was not consistent when each time point was analyzed separately. On the placebo day, serum lipase levels measured by ELISA after an ad libitum meal rose slightly compared to the preprandial values (P = 0.003). There was strong correlation between serum lipase levels measured by ELISA and LIPC Lipase colorimetric assay (COBAS) (0.94 < r; <0.0001). Infusions of GLP‐1 and PYY 3‐36, separately or in combination, did not increase serum lipase. However, a small increase in serum lipase may occur in response to a meal.

SIGNIFICANCE OF SERUM AMYLASE AND SERUM LIPASE LEVELS IN ACUTE ORGANOPHOSPEROUS POISONING.

31Aug 2016 SIGNIFICANCE OF SERUM AMYLASE AND SERUM LIPASE LEVELS IN ACUTE ORGANOPHOSPEROUS POISONING. Anjay B , JayasinghK , Tumbanatham A , Green SR and Ezhumalai G. Junior resident. Professor and head of the department. Assistant professor. Senior statistician.

Case report of a renal cell carcinoma patient with acute pancreatitis under both sunitinib and axitinib treatment

Abstract Sunitinib and axitinib are oral tyrosine kinase inhibitors (TKI) that is commonly used in the treatment of metastatic renal cell carcinoma (RCC) as it has been shown to improve the progression-free survival of patients compared with sorafenib. Hypertension, palmar-plantar erythrodysesthesia, diarrhea, decreased appetite, nausea, and fatigue are common adverse events associated with them. We declared the first case report of a RCC patient with acute pancreatitis both under sunitinib and axitinib treatment. A 63-year-old male RCC patient who had been previously treated with interferon alfa 2b, sunitinib, everolimus and axitinib was hospitalized for acute pancreatitis four months after the onset of sunitinib therapy and five months after the onset of axitinib treatment. Symptoms and levels of serum lipase were normalized within one week after drug was withheld. Acute pancreatitis is a rare side effect of TKI and because of this, in patients under TKI treatment abdominal pain should be considered as a possible symptom of acute pancreatitis.

Predicting post-endoscopic retrograde cholangiopancreatography pancreatitis using the 4-h serum lipase level.

Endoscopic retrograde cholangiopancreatography (ERCP) is a complex therapeutic procedure that is complicated by pancreatitis in 3-5% of cases. The aim of this study is to determine whether a 4-h post-ERCP serum lipase level is superior to the serum amylase level in predicting the occurrence of post-ERCP pancreatitis (PEP). We performed a retrospective review of prospectively collected data on 543 consecutive patients undergoing therapeutic ERCP at a single centre. Serum lipase and amylase levels were measured at 4-h post-procedure and were recorded as a factor of the upper limit of normal: amylase factor (AF) and lipase factor (LF). Sensitivity and specificity were compared using receiver-operating characteristics and the Youden index (YI). A total of 506 procedures were considered for analysis. PEP occurred in 19 patients (3.8%). A LF of <10 was useful for the exclusion of PEP with a sensitivity of 100% and a specificity of 94%, YI = 0.94. In contrast, an AF <3 yielded a sensitivity of 79% and specificity of 94%, YI = 0.73. Serum lipase measured at 4-h post-ERCP better excludes PEP than serum amylase measured at the same time point. Patients with a LF <10 may be safely considered for same-day discharge.

No Benefit of Oral Diclofenac on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

Pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is a serious complication. Rectal diclofenac (100mg) has been shown to reduce the incidence of pancreatitis; however, this dosage form is unavailable in several countries. We aimed to investigate the preventive effect of oral diclofenac on pancreatitis after ERCP in a multicenter, randomized, prospective, placebo-controlled, double-blind trial. Patients undergoing a first ERCP in seven high-volume centers between July 2012 and August 2014 were considered eligible. Participants were administered oral diclofenac (50mg) or placebo before and after ERCP. The primary endpoint was the incidence of pancreatitis. A subgroup analysis was performed for patients at high or low risk of pancreatitis. Secondary endpoints were pancreatic enzyme levels (amylase and lipase). We initially enrolled 430 patients (216 in the diclofenac and 214 in the placebo group), and 23 were excluded after randomization. The overall incidence of pancreatitis was 9.8% (20/205) and 9.4% (19/202) in the diclofenac and placebo groups, respectively (p=0.90). The incidence of pancreatitis was 20.3% (13/64) and 21.3% (13/61) in patients at high risk of pancreatitis (p=0.78) and 5.0% (7/141) and 4.3% (6/141) in patients at low risk of pancreatitis in the diclofenac and placebo groups (p=0.94), respectively. There were no significant differences in serum amylase and lipase levels between the two groups before and 24h after ERCP. Oral administration of diclofenac before and after ERCP showed no benefit in the prevention of pancreatitis. UMIN000008109.

Abstract 3122: A strategy for detecting high-risk groups for pancreatic cancer with glycol-biomarkers

Abstract (Aim) Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal cancers, showing a high potential for invasive activity and high recurrence rates. One of the reasons for poor prognosis of PDAC is a difficulty in an early diagnosis. When pancreatic tumors are detected by CT or MRI examinations, most cases are at the advanced stage even if tumor size is within 2 cm. To make an early diagnosis for PDAC truely, we should make a targeting of high-risk groups for developing PDAC like chronic hepatitis followed by hepatocellular carcinoma. Aberrant glycosylation is a promising target for cancer biomarkers. Several kinds of glyco-biomarkers are clinically used for PDAC diagnosis like CA19-9. We have reported that fucosylated haptoglobin (Fuc-Hpt) is a novel type of glyco-biomarker for PDAC. Serum Fuc-Hpt levels are dramatically increased at the stage IV of PDAC as well as a few cases of Stage I-III. In the present study, we performed pathological analysis of surrounding tissues around pancreatic cancer as well as normal pancreas in autopsy cases and investigated the clinical usefulness of glycol-biomarkers for chronic pancreatitis and pancreatic cancer (Subjects and Methods) 88 cases of pancreatic cancer patients and 100 cases of other diseases are enrolled in this study. Inflammation, fibrosis and fatty changes were investigated in these pancreatic tissues by 2 independent researchers in blind way. Serum fucosylated haptoglobin (Fuc-Hpt) levels in patients with chronic pancreatitis and pancreatic cancer were measured with lectin-antibody ELISA, using Aleuria aurantia lectin (AAL) and Pholiota squarrosa lectin (PhoSL). AAL recognizes all types of fucosylation and PhoSL recognizes core fucosylation. (Results) Pancreatectomy specimens showed a higher ratio of positive change in fibrosis (86% vs. 42%), fatty degeneration (72% vs. 44%), and inflammatory cell infiltration (14% vs. 3%) than control samples. Multivariate analyses demonstrated that each histological change was a significant, independent determinant for PDAC. In contrast, AAL-reactive Fuc-Hpt levels were increased in patients with pancreatic cancer and AAL-reactive Fuc-Hpt was though to be produced in the liver metastasis of pancreatic cancer. In contrast, PhoSL-reactive Fuc-Hpt levels were increased in patients with chronic pancreatitis, compared to pancreatic cancer. Correlations of PhoSL-reactive Fuc-Hpt levels and other biochemical parameters such as serum amylase, lipase, and elastase levels were not observed. The investigation of mechanisms underlying an increase of serum PhoSL-reactive Fuc-Hpt in patients with chronic pancreatitis is underway. (Conclusion) Cryptogenic pancreatitis might be a premalignant disease for pancreatic cancer and dramatic changes in fucosylation linkage on Fuc-Hpt were observed in pancreatic carcinogenesis. These findings give us a possibility of preventing or diagnosing pancreatic cancer at earlier stage, chronic pancreatitis. Citation Format: Eiji Miyoshi, Tomohiro Maekawa, Makiko Ueda, Mayuka Shimomura, Shinji Takamatsu, Kotarosumitomo Nakayama, Yoshihiro Kamada, Yasuhiko Tomita. A strategy for detecting high-risk groups for pancreatic cancer with glycol-biomarkers. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3122.

Predictive value of low serum pancreatic enzymes in invasive intraductal papillary mucinous neoplasms

BackgroundDespite evidence suggesting a role of chronic pancreatitis in pancreatic carcinogenesis, its relationship with invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. Low levels of pancreatic enzymes are predictive markers of advanced chronic pancreatitis. We investigated whether low pancreatic enzyme levels were associated with a higher incidence of invasive IPMN. MethodsThis study included 146 consecutive patients who underwent surgical resection of IPMN between April 2001 and October 2014. Multivariable logistic regression analysis was conducted to assess the association between serum pancreatic enzymes and the incidence of invasive IPMN, with adjustment for clinical characteristics including alcohol consumption. The association of serum pancreatic enzymes with pathological pancreatic atrophy and inflammation in areas adjacent to or distant from the tumor was also evaluated. ResultsLow serum levels of pancreatic amylase and lipase were associated with a higher incidence of invasive IPMN (multivariable odds ratio [OR] = 9.6, 95% confidence interval [CI] = 2.99 to 35.1, P = 0.0001; OR = 14.2, 95% CI = 2.77 to 112, P = 0.001, respectively). Low serum pancreatic amylase and lipase levels were also associated with higher grade pancreatic atrophy in areas adjacent to the tumor (P = 0.011 and P = 0.017, respectively) and in areas distant from the tumor (P = 0.0002 and P = 0.001, respectively). Furthermore, low serum pancreatic amylase and lipase levels were associated with higher grade inflammation in areas distant from the tumor (P < 0.0001 and P = 0.001, respectively). ConclusionsLow serum pancreatic enzymes may be a predictive marker of invasive IPMN. Excessive alcohol consumption did not influence the association of low pancreatic enzyme levels with invasive IPMN.

Origin, Presentation, and Clinical Course of Nonpancreatic Hyperlipasemia.

The diagnosis of acute pancreatitis (AP) is defined as a constellation of abnormal pancreatic enzymes, imaging, and characteristic pain. The origin and clinical significance of isolated hyperlipasemia is unclear. We prospectively evaluated patients with serum lipase level greater than 3 times the upper limit of normal (ULN) admitted to Los Angeles County Hospital from October 2014 to April 2015. Patients were identified by a daily laboratory query used to support an ongoing randomized trial of goal-directed therapy for AP (NCT 01761539). Nonpancreatic hyperlipasemia (NPHL) was defined as a serum lipase level greater than 3 times the ULN without characteristic pain or imaging. Among 221 patients with lipase level greater than 3 times the ULN, 170 met criterion for AP, and 51 did not. The leading etiologies for NPHL were decompensated cirrhosis and renal failure. Patients with NPHL were significantly older and had more comorbidities and lower serum lipase levels (360 ± 36 vs 1453 ± 135 IU/L, P < 0.001). There were no differences in length of hospitalization, intensive care unit admission, or mortality. Elevated serum lipase level has many nonpancreatic origins, with liver and renal failure being the most frequent. Distinct clinical features can help to differentiate between AP and NPHL.

LEADER and the new ‘cardiovascular’ glucose‐lowering agents

<scp>LEADER</scp> and the new ‘cardiovascular’ glucose‐lowering agents

Incidence and predictors of oral feeding intolerance in acute pancreatitis: A systematic review, meta-analysis, and meta-regression

Tolerance of oral food is an important criterion for hospital discharge in patients with acute pancreatitis. Patients who develop oral feeding intolerance have prolonged hospitalisation, use additional healthcare resources, and have impaired quality of life. This study aimed to quantify the incidence of oral feeding intolerance, the effect of confounders, and determine the best predictors of oral feeding intolerance. Clinical studies indexed in three electronic databases (EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials) were reviewed. Incidence and predictor data were meta-analysed and possible confounders were investigated by meta-regression analysis. A total of 22 studies with 2024 patients met the inclusion criteria, 17 of which (with 1550 patients) were suitable for meta-analysis. The incidence of oral feeding intolerance was 16.3%, and was not affected by WHO region, age, sex, or aetiology of acute pancreatitis. Nine of the 22 studies investigated a total of 62 different predictors of oral feeding intolerance. Serum lipase level prior to refeeding, pleural effusions, (peri)pancreatic collections, Ranson score, and Balthazar score were found to be statistically significant in meta-analyses. Oral feeding intolerance affects approximately 1 in 6 patients with acute pancreatitis. Serum lipase levels of more than 2.5 times the upper limit of normal prior to refeeding is a potentially useful threshold to identify patients at high risk of developing oral feeding intolerance.

Low lipase levels as an independent marker of pancreatic cancer: A frequently neglected condition in clinical setting

Background/Aims: Low lipase levels, which may be an indication of low production due to organ failure, are frequently encountered in a clinical setting, but are usually overlooked. This study examined the values of low serum lipase levels and other clinical parameters in the diagnosis of several clinical conditions, such as in pancreatic cancer. Materials and Methods: Patients with low lipase levels (≤8 U/L) were included in this retrospective study. Clinical data, including diagnostic category, demographic properties, and biochemical and hematological measurements, including serum lipase levels, were extracted. A multivariate analysis was used to identify the independent predictors of certain diagnostic categories. Results: A total of 198 patients with low lipase levels were included. Among these patients with low lipase levels, 45 (22.7%) were diagnosed with pancreas cancer. Multivariate analysis identified low lipase level as a significant predictor of pancreas cancer (OR 0.70 [%95 CI, 0.52–0.93], p=0.02). For predicting pancreatic cancer, an optimal cut-off value of ≤5.5 U/L for lipase was utilized, which had a sensitivity and specificity of 76% and 37%, respectively. Conclusion: Low lipase levels close to zero may be an indication of pancreatic cancer and should not be underestimated in the clinical setting. However, large studies are warranted to delineate the exact diagnostic significance of such low lipase levels.

Can serum amylase and lipase levels be used as diagnostic markers to distinguish between patients with mucinous cystic lesions of the pancreas, chronic pancreatitis and pancreatic ductal adenocarcinoma?

Can serum amylase and lipase levels be used as diagnostic markers to distinguish between patients with mucinous cystic lesions of the pancreas, chronic pancreatitis and pancreatic ductal adenocarcinoma?

Novel patient-derived xenograft mouse model for pancreatic acinar cell carcinoma demonstrates single agent activity of oxaliplatin.

BackgroundPancreatic acinar cell carcinoma (PACC) is a rare malignancy, accounting for <1 % of all pancreatic neoplasms. Very few retrospective studies are available to help guide management. We previously reported the case of a patient with metastatic PACC who achieved prolonged survival following doxorubicin treatment. Personalized treatment was based on molecular and in vitro data collected from primary cells developed from their liver metastasis. We now report the characterization of a patient derived tumor xenograft (PDTX) mouse model that originated from this patient’s PACC liver metastasis.MethodsFragments of biopsy tissue (5 mm3) from PACC liver metastasis were implanted into athymic nude mice. Tumors were grown and passaged from the host mice into new mice to be tested for therapeutic response. Immuno-histochemical (IHC) biomarkers were used to confirm that the PDTX model represents human PACC. The antitumor activities of multiple drugs (5-FU, irinotecan, oxaliplatin, gemcitabine, bevacizumab, erlotinib, doxorubicin and imatinib) were tested. Tumor size was measured over 74 days or until they reached an endpoint volume of ~800 mm3. Tests to measure serum lipase levels and histological analyses of tumor tissues were also conducted to assess PACC progression and re-differentiation.ResultsThe model presented here expresses the same IHC markers found in human PACC. In the chemotherapy study, oxaliplatin produced a prolonged durable growth response associated with increased apoptosis, decreased serum lipase levels and increased healthy acinar cells. Bevacizumab also produced a significant growth response, but the effect was not prolonged as demonstrated by oxaliplatin treatment. The other chemotherapies had moderate to little effect, particularly after treatment ceased. Mutations in DNA repair genes are common in PACC and increase tumor susceptibility to oxaliplatin. To explore this we performed IHC and found no nuclear expression of BRCA2 in our model, indicating a mutation affecting nuclear localization. Gene sequencing confirms BRCA2 has a homozygous gene deletion on Exon 10, which frequently causes a protein truncation.ConclusionsIn summary, we report the development and characterization of the first and only preclinical PACC PDTX model. Here we show sustained anti-tumor activity of single agent oxaliplatin, a compound that is more effective in tumors that harbor mutations in DNA repair genes. Our data shows that BRCA2 is mutated in our PACC model, which could contribute to the oxaliplatin sensitivity observed. Further studies on this rare PACC model can serve to elucidate other novel therapies, biomarkers, and molecular mechanisms of signaling and drug resistance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-0875-z) contains supplementary material, which is available to authorized users.

Perfusion-CT--Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

PurposeSevere acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.Material and Methods79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4–6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.ResultsStatistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.ConclusionsCT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.

Role of Amylase and Lipase Levels in Diagnosis of Blunt Trauma Abdomen.

Blunt Trauma Abdomen (BTA) is the leading cause of morbidity and mortality amongst all age groups. Spectrum of injury may vary from simple to life threatening multi organ involvement and therefore proper assessment and diagnosis becomes very important. To evaluate the role of serum amylase and lipase in diagnosis of blunt trauma abdomen. This study was done on 50 patients with diagnosis of BTA admitted in Dayanand Medical College and Hospital, Ludhiana. Serum amylase and lipase levels were estimated on days 1, 3 and 5 of admission. Road side accident was the most common aetiology accounting for 40 patients. Thirty one patients were less than 35 years of age and 42 patients were males. Abdominal tenderness was the most common per abdomen finding, found in 31 patients, followed by distension, found in 21 patients. The most common organ injured was liver, seen in 27 patients. Fifteen patients underwent laparotomy while 35 patients were managed conservatively. There was statistically significant rise in serum amylase levels on days 1, 3 and 5 in patients with small and large intestinal injury. There was statistically significant rise in serum lipase levels on days 1, 3 and 5 in patients with stomach injury. Raised levels of serum amylase and lipase had a statistically significant prediction for the need of surgery in these patients. Serum amylase and lipase levels, when coupled with other laboratory tests and imaging modalities, may have significant role in predicting the site of injury as well as the surgical outcome in patients of BTA.

Serum Lipase as Clinical Laboratory Index for Chronic Renal Failure Diagnosis.

Measuring the level of serum lipase has been used for the clinical diagnosis of acute pancreatitis. Reports showed that the serum lipase level increased in patients of clinical renal failure. In this study, we aimed to measure the change of serum lipase levels in chronic kidney diseases and determine whether it could serve as a clinical laboratory index for clinical renal failure diagnosis. Materials: The OLYMPUS AU5400 automatic biochemical analyzer was used to determine the serum levels of lipase and creatinine. The study included 120 cases in the clinical renal failure group, 76 cases in the nephrotic syndrome group, 81 cases in the chronic nephritis group, and 80 healthy controls from our hospital volunteers in the same period. We then compared the lipase levels and conducted statistical analyses among these groups. The serum lipase levels were 15.3 U/L, 79.8 U/L, 45.1 U/L, and 51.0 U/L in the normal control, clinical renal failure, nephrotic syndrome, and chronic nephritis groups, respectively. The lipase levels in the groups with diseases were significantly different compared with that of the normal control group (p < 0.01). The lipase level of the clinical renal failure group was significantly higher than that of the nephrotic syndrome group and chronic nephritis group (p < 0.01). However, no statistically significant difference between the nephrotic syndrome and chronic nephritis group (p > 0.05) was observed. Moreover, an association of the serum lipase with disease progression was observed in the study. Serum lipase is an effective serological index which can reflect the clinical changes in the clinical renal failure and tends to increase through the progression of renal dysfunction.

Pancreatic injury in patients with septic shock: A literature review.

Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.

A Rare Cause of Acute Pancreatitis: Unexpected Travel of the Biliary Catheter.

To the Editor, Biliary leakage is an important complication that occurs after cholecystectomy (1). Unless uncomplicated, it generally closes spontaneously if there is no distal obstruction (2). The therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedure is helpful in the clearance of biliary flow and lowering the biliary pressure (3). In case of insufficiency of the ERCP procedure, percutaneous biliary drainage maneuvers can help to control biliary fistulas or save time for surgery (4,5). We present a case of bile leakage which occurred after laparoscopic cholecystectomy, where we encountered an interesting cause of acute pancreatitis. A 32 year-old woman who underwent a laparoscopic cholecystectomy two weeks previously was referred to us with a drain placed in the operation wound, suggesting bile leakage. Physical examination revealed disseminated tenderness of the abdomen. Transaminase, amylase and lipase levels were normal. Computed tomography scan showed a 10 cm fluid collection in the sub-hepatic area. We followed her up for two weeks with the drainage of 200 mL of bile daily. A magnetic resonance cholangiopancreatography imaging was obtained showing some sludge and stone of 22 mm in the distal common hepatic duct (CHD). An ERCP was applied, where the pancreatic duct was found to be widened, but CHD could not be cannulated. An 8 F pigtail-locked percutaneous internal-external biliary drainage catheter (Flexima® Drainage Catheters, Boston Scientific; Natick, MA, USA) was placed and a prominent leakage from the cystic duct stump was demonstrated in cholangiography (Figure 1a). Fluid collection diminished by the 24th day. During the second catheter cholangiography, some small stones were pushed into the duodenum by a balloon catheter. One big stone, which remained in place, was extracted on the following day, by a successful ERCP procedure performed with the guidance of a biliary catheter (Figure 1b). Oral feeding was never paused. The intra-abdominal drainage catheter was removed and the patient was discharged on the 33rd day with the biliary catheter. On the 15th day of discharge, she presented with abdominal pain. Laboratory assessment demonstrated a marked elevation in serum amylase and lipase levels. She was re-hospitalized for acute pancreatitis. A control catheter cholangiogram showed an unexpected migration of the catheter into the duct of Virsung, which clarified the etiology of acute pancreatitis (Figure 1c). The catheter was repositioned (Figure 1d) and she was discharged on the following day. A spontaneous closure of the leakage was observed on a consequent catheter cholangiogram obtained a week later. The biliary catheter was removed and the patient visited the outpatient clinic without any complaint after three weeks. FIG. 1. a, b. Cholangiography film obtained after the internal-external biliary drainage catheter is placed. Biliary leakage at the level of cystic duct stump (white arrow). Image of stone or sludge at the level of distal common bile duct (CBD) (white arrow head). ... Biliary drainage catheters are loyal assistants of surgeons. Unless hemobilia or bilhemia occurs, they serve as lifeguards in biliary problems, whereas catheters are foreign bodies and can sometimes make matters worse. When a patient being followed-up with a percutaneous biliary catheter exhibits a state of sudden acute pancreatitis, besides other common reasons, catheter migration through the duct of Virsung must be kept in mind. This case seems to be the first in the literature demonstrating a biliary catheter responsible for acute pancreatitis by migrating into the duct of Virsung.

A clinical study of acute pancreatitis

Background: Acute pancreatitis is an acute inflammatory process of the pancreas with varying involvement of other regional tissues or remote organ systems. About 80% of the attacks are mild, 20% are severe and they are commonly accompanied by necrosis of the pancreas and or organ failure. The objective of the study was to determine the correlation between Ranson’s score, CT severity index and pancreatic enzymes in acute pancreatitis. Methods: In the present study 150 patients were included who had clinical features of acute pancreatitis and CECT abdomen suggestive of acute pancreatitis. Patients with chronic pancreatitis were excluded from the study. Patients were admitted to the hospital and CECT abdomen was performed 48 hours after the onset of symptoms. Liver function tests, complete blood picture, serum calcium and pancreatic enzymes were assessed at the time of admission, after 48 hrs and weekly thereafter till discharge. Patients were followed up with regular spontaneous visits, telephonic intimation and through postcard. Results: Majority of the patients were in the age group of 20-40 (72%). It was more common in males (m:f)=(9:1). In general, ethanol abuse was more common cause while in females gall stone was the major cause. There was a good correlation between Ranson’s score and CT severity index score. The magnitude of enzyme elevation had no correlation with the severity of the disease. On follow up common complications were Pseudo cyst of the pancreas, Splenic vein thrombosis, Left sided pleural effusion. Conclusions: This study concludes that there is a good correlation between CT severity index and Ranson’s score with respect to severity of the acute pancreatitis. Serum amylase and lipase levels have little role in terms of severity of acute pancreatitis.