Presence Of Pancreatitis Research Articles

7947 Semaglutide Induced Pancreatitis: A Case Report

Abstract Disclosure: T. Altaweel: None. A. Mathew: None. P. Chalasani: None. L. Lawrence: None. S. Hussain: None. N. Aldaoud: None. Introduction/Background: As semaglutide (GLP1 RA) has become a cornerstone in diabetes and weight management, there have been studies indicating pancreatic inflammation with GLP1 RA use. We report a case of acute necrotizing pancreatitis secondary to semaglutide use.Clinical Case: A 52 year old male with a history of hypertension, morbid obesity with BMI of 40 kg/m2, alcohol induced pancreatitis presented to the hospital complaining of epigastric pain. On presentation, he appeared in distress due to pain but was hemodynamically stable. Physical examination revealed a moderately distended abdomen, tender to palpation over the epigastric area without guarding, and negative Murphy’s sign. The patient reported no alcohol consumption, tobacco usage, or recent abdominal injuries. Laboratory workup revealed elevated WBC 14.6 thous/mcL (4.5-10.5) and lipase 1941 U/L (<60). Abdominal ultrasound showed common bile duct 2 mm without gallstones and CT abdomen revealed acute pancreatitis with suspected necrosis in the pancreatic head and the pancreatic tail. Patient was started on aggressive fluid hydration, pain management and admitted to intensive care. Patient reported that he was started on semaglutide three months ago for weight management by his primary care physician. Patient improved symptomatically with pain control and tolerated oral intake. He was discharged home with recommendations not to resume semaglutide. Conclusion: Semaglutide involves direct stimulation of GLP-1 receptors in pancreatic cells, potentially leading to cell overgrowth, increased pancreatic weight, duct occlusion and inflammation. Despite the SUSTAIN-6 trial indicating no increased risk of acute pancreatitis in diabetic patients using semaglutide, atypical presentations of pancreatitis are noted in patients using the medication for weight management. When all identifiable causes of pancreatitis are eliminated, semaglutide-induced pancreatitis should be a primary consideration in the differential diagnosis. Physicians should exercise caution and give careful consideration when prescribing semaglutide for weight management in patients with conditions that increase risk for pancreatitis. Presentation: 6/2/2024

Immunoglobulin G4-related pancreatitis presenting as an obstructive pancreatic mass in a Latino male

Immunoglobulin G4-related disease (IgG4-RD) is a localized or diffuse autoimmune fibro-inflammatory condition that can affect any organ. The literature is sparse on IgG4-RD in the Latino population. This is a case report of a Latino male diagnosed with IgG4-related pancreatitis presenting as a mass. Our 40-year-old Latino male patient presented with diarrhea and epigastric discomfort progressing to jaundice and pruritus. He had associated elevations in liver enzymes, antinuclear antibody, and IgG4. Magnetic resonance cholangiopancreatography revealed a lobulated pancreatic head mass with common bile duct (CBD) narrowing. Endoscopic ultrasound-guided biopsy of the pancreas revealed no malignancy, and the patient underwent CBD stenting through endoscopic retrograde cholangiopancreatography. The patient demonstrated a favorable response to systemic glucocorticoid therapy with resolution of his symptoms and normalization of his liver function tests. Coronavirus disease-2019 infection during treatment had no impact on the outcomes.

Atypical Presentation of Pancreatitis in a 39-year-old male

Atypical Presentation of Pancreatitis in a 39-year-old male

Robotic Spleen-Preserving Distal Pancreatectomy: The Warshaw and Kimura Techniques.

Spleen-preserving distal pancreatectomy offers an alternative surgical approach to the traditional distal pancreatectomy combined with splenectomy for removing benign and low-grade malignant lesions in the distal pancreas, avoiding complications associated with splenectomy. This procedure can be accomplished either by resecting and ligating the splenic vessels (Warshaw technique) or by preserving them (Kimura technique). Currently, the widespread use of minimally invasive surgery has established laparoscopic and robotic approaches for spleen-preserving distal pancreatectomy as valid and safe options for treating such conditions. Our protocol aims to describe how the Warshaw and Kimura techniques of spleen-preserving distal pancreatectomy can be performed robotically. The first patient is a 36-year-old female with a neuroendocrine tumor (NET) in the pancreatic body who underwent a spleen-preserving distal pancreatectomy with the ligation of the splenic vessels (WT). The second patient is a 76-year-old male with chronic pancreatitis presenting with a dilated main pancreatic duct in the tail of the pancreas who underwent a spleen-preserving distal pancreatectomy with a vessel-preserving approach (KT).

Immunotherapy induced endocrinopathies: "pembrolizumab-induced pancreatitis presenting as diabetic ketoacidosis with concurrent hyperthyroidism-related atrial fibrillation"

Immunotherapy induced endocrinopathies: "pembrolizumab-induced pancreatitis presenting as diabetic ketoacidosis with concurrent hyperthyroidism-related atrial fibrillation"

Pancreatitis in cystic fibrosis: Presentation, medical and surgical management, and the impact of modulator therapies.

Patients with Cystic Fibrosis (CF) are at increased risk of acute (AP) and chronic (CP) pancreatitis, and their complications. The extent of remaining healthy pancreatic parenchyma determines the risk of developing future episodes of pancreatitis, as well as pancreatic exocrine or endocrine insufficiency. Pancreatitis may be the presenting symptom of CF, and genetic testing is especially important in pediatrics. AP and recurrent AP are managed with intravenous fluid hydration and pain control, in addition to early refeeding and treatment of complications. With the use of modulator therapy in CF, pancreatic function may be restored to some extent. CP related pain is managed with analgesics and neuromodulators, with surgery if indicated in specific situations including TPIAT as a possible type of surgical intervention. Long-term sequelae of CP in patients with CF include exocrine pancreatic insufficiency treated with pancreatic enzyme replacement therapy, fat-soluble vitamin deficiencies and associated metabolic complications such as bone disease/osteoporosis, pancreatogenic diabetes, and less commonly, pancreatic cancer. We review the presentation and etiologies of pancreatitis in CF patients as well as the management of AP and CP primarily in children.

An unusual presentation of acute pancreatitis associated with primary hyperparathyroidism in pregnant woman

An unusual presentation of acute pancreatitis associated with primary hyperparathyroidism in pregnant woman

Pancreatic necrosis eroding duodenum as a complication of acute pancreatitis presenting with upper GI bleed – a case report

Pancreatic necrosis eroding duodenum as a complication of acute pancreatitis presenting with upper GI bleed – a case report

Ruptura pankreasne pseudoaneurizme kao posledice hroničnog pankreatitisa - prikaz slučaja

Abstract: Introduction: Pseudoaneurysms of the pancreaticoduodenal arcade are rare, accounting for approximately 2% of all visceral artery aneurysms. They typically arise as complications of chronic pancreatitis, peptic ulcer disease, trauma, pancreatic and biliary surgery, or pancreas transplantation. Diagnosis often occurs only after rupture, leading to life-threatening internal bleeding. Bleeding may occur within a pseudocyst, with blood passing through the Vater's papilla into the digestive tract, or may result in the formation of a retroperitoneal hematoma that can rupture into the abdominal cavity, causing hemoperitoneum. The cell-saver is a tool that can be utilized for intraoperative blood cell salvage and autologous transfusions. Case Report: Our patient, a 54-year-old male, an untreated alcoholic with no prior medical history or documented treatment, presented to the Clinic for Emergency Surgery at the University Clinical Center of Serbia with a sudden onset of upper abdominal pain. A quick ultrasound of the abdomen was performed, followed by an urgent CT scan of the chest and abdomen, revealing a hematoma extending from the right retroperitoneum and mesentery of the intestine, measuring 150x109x180mm in diameter, with signs of active bleeding in the region beneath the pancreas, indicative of hemoperitoneum. Due to hemodynamic instability, accompanied by a drop in arterial blood pressure and hemoglobin levels, an urgent laparotomy was performed. Active bleeding was identified from a ruptured pseudoaneurysm originating from the pancreaticoduodenal arcade. Hemostasis was achieved followed by tamponade, and the tampons were removed 30 hours post-surgery. The patient remained hemodynamically stable thereafter, recovered well from the surgery, and was discharged home in good general condition. Intraoperatively, we utilized the Cell-saver to collect the patient's blood and subsequently administered autologous transfusion. Conclusion: In patients with chronic pancreatitis presenting with sudden abdominal pain and hemodynamic instability accompanied by a drop in arterial pressure, hemoglobin, and hematocrit levels, the possibility of a ruptured pseudoaneurysm in the pancreatic or peripancreatic region should be considered. Timely diagnosis and prompt surgical intervention are crucial for a successful outcome. Effective collaboration among radiologists, anesthesiologists, and surgeons is essential. The utilization of the Cell-saver system significantly aids in maintaining cardiac output and hemodynamic stability in these patients.

Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass: A Proof-of-Concept Study.

Inflammatory head mass of pancreas (IMP) developing in background of chronic pancreatitis (CP) is difficult to distinguish from carcinoma pancreas. We aimed to delineate natural course of IMP and predict their malignancy risk, avoiding unnecessary biopsies. In this retrospective single-center study, clinical records of patients with CP with diagnosed pancreatic head mass were reviewed. Clinical, laboratory, imaging, endoscopic findings, and follow-up details were retrieved from prospectively maintained database. A diagnostic nomogram was developed combining serum cancer antigen 19-9 and endoscopic ultrasound (EUS) findings to predict the risk of malignancy. We identified 107 patients with pancreatic head mass with CP of whom 87 (81.3%) were IMP and 20 (18.7%) were malignant. Patients with IMP were more frequently young males with alcohol-related CP and low CA 19-9 in comparison with those with malignancy (age IMP: 41.3 ± 11.3 vs carcinoma: 49.3 ± 14.5 years [ P = 0.009]; males 89.7% vs 65% [ P = 0.011]; alcoholic etiology: 71.3% vs 20% [ P < 0.001]; median CA 19-9: 25.78 [interquartile range, 7.20-120.60] vs 1034.50 [106.65-7808.25] [ P < 0.001]). A diagnostic nomogram combining CA 19-9 and EUS findings could identify malignancy with an optimism-corrected c-statistic of 0.905, which was better than both CA 19-9 (0.80) and EUS alone (0.826). Patients with IMP had relatively benign disease course with 40.2% biliary obstruction, 20.7% portal venous thrombosis, 14.9% gastric outlet obstruction, and 1-, 3-, and 5-year survival being 97.3%, 92.7%, and 92.0%, respectively. Surgery was required in only 12 patients (13.8%) with IMP. Combination of CA 19-9 and EUS best identifies malignancy risk in patients with IMP, who have otherwise benign course.

Causal Evaluation of Pancreatitis in Children

Pancreatitis in childhood is not common. It can be associated with severe morbidity and mortality. The role of clinicalevaluation is vital as it can be misdiagnosed easily. This study was aimed to review the prevalence, etiology,presentation and outcome of pancreatitis in children. This cross-sectional study was conducted at the Department ofPediatric Gastroenterology &amp; Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January,2017 through June, 2018. A total 43 cases of pancreatitis were included in this study. Pancreatitis was classified asacute pancreatitis(AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) as per diagnostic criteriamade by INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) group. Among 43children (age 10.1 mean ± 2.55,18 males); AP,14 (32.6%); ARP, 14(32.6%) and CP,15(34.8 %). Half of AP wasidiopathic. Majority of ARP (28.6%) were idiopathic and CP (40%) had calcific pancreatitis. Majority of patients hadvomiting followed by moderate to severe abdominal pain. In CP 4(26.6%) patient developed diabetes mellitus.Majority of pancreatitis in children is idiopathic. A sub-set of AP goes on to develop ARP and CP on follow-up andbeing in the idiopathic sub-set is a risk factor. CP is progress to endocrine and exocrine insufficiency. Early diagnosis,close monitoring and proper intervention are mandatory to reduce the potential morbidity and mortality. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):76-79

S2125 A Rare Presentation of Drug-Induced Pancreatitis After Cyclophosphamide Infusion

S2125 A Rare Presentation of Drug-Induced Pancreatitis After Cyclophosphamide Infusion

S2082 A Rare Case of Hemorrhagic Groove Pancreatitis Presenting as Duodenal Obstruction

S2082 A Rare Case of Hemorrhagic Groove Pancreatitis Presenting as Duodenal Obstruction

Female patients delay seeking medical care with alcohol-associated acute pancreatitis

Background/Objective: Alcohol consumption is increasing in women, who more frequently report abdominal symptoms compared to men. We aimed to examine differences in presentation of acute pancreatitis [AP] in male and female patients hospitalized with alcohol-associated AP. MethodsWe analyzed 138 patients enrolled in an ongoing case-crossover study of alcohol-associated AP conducted across 5 medical centers in the U.S. Patients meeting the Revised Atlanta Classification of AP and who scored 3 or higher on the AUDIT-C instrument were invited to participate in the study and were interviewed while hospitalized with AP. Sex differences in the timing and type of pancreas-associated pain, alcohol consumption, clinical presentation, and quality of life were examined by Chi-squared tests, Wilcoxon rank sum tests and t-tests. ResultsFemale patients reported significantly longer interval from onset of pain to deciding to seek medical attention (median 40 h, interquartile range [IQR] 14, 74) as compared to males (14 h, IQR 4, 50; p = 0.005). While male patients were more likely to have been admitted to the intensive care unit [ICU] (21%) as compared to female patients (7%; p = 0.04), the incidence of SIRS or severe AP did not differ by sex. Quality of life measures as reported through the PROMIS-29 instrument were equally suboptimal in both sexes. Anxiety disorders were diagnosed more frequently among females (61%) than in males (41%, p = 0.009). ConclusionIn a large case series of alcohol-associated AP, we found that female patients delayed seeking medical care compared to males. However, there were no differences in the type, location and intensity of abdominal pain.

Gender differences in the epidemiology and clinical presentation of acute pancreatitis

Background: Patients with chronic pancreatitis can suffer from a range of intense pain, as well as problems related to the functioning of the digestive organs, the evaluation of the quality of life can provide valuable information about the level of physical and emotional discomfort felt by the patients after the surgical intervention. Methods: A prospective study was carried out in the period 2014-2020 in which 113 patients with benign pancreatic pathology treated surgically admitted to the CF2 Clinical Hospital in Bucharest were included. For this study, the statistical method of simple linear regression was applied. Results: Patients' quality of life can also be influenced by the level of social support and medical care they receive. A strong support network, which can provide emotional and practical support, as well as access to appropriate and specialist medical care, can play an important role in managing symptoms and improving patients' quality of life. Conclusions: Although patients in this study experienced significant improvement in symptoms and ability to perform daily activities, it is important to pay attention to and manage persistent symptoms and postoperative complications to ensure the best possible quality of life.

1363-P: Clinical Profile and Outcome of Diabetic Ketoacidosis in an Emergency Department Non-COVID ICU

The clinical profile of DKA in a 4-bedded ED ICU of a single tertiary care centre from 12 April 2022 to 4 January 2023 is presented. A total of 11 DKA events were managed, with a mean age of 45.5 ± 19.2 y with M: F ratio of 1:2.7. Type 1 in 36%, type 2 in 45% and 18% were unclassified. 55% had no comorbidities, and 45% had Hypertension, CAD, CKD, and hypothyroidism. Presented with nausea &amp; vomiting in 6 (55 %), shortness of breath in 5 (45%), dysuria in 4 (36 %), fever &amp; fatiguability in 3 (27%), abdominal pain, chest pain, loose stools in 2 (18%), cough, haematemesis and loss of consciousness in 1 (9%). Of the total patients, 36 % were only on OADs, 18 % on Insulin and OADs and 18 % on Insulin alone. Duration of diabetes ranged from 2 to 13 years, and 2 were first diagnosed. Reasons for DKA were Non-adherence to medication (18%), the first presentation of DM (18%), Infections (73%), CAD-ACS (18%) and Pancreatitis (9%). One patient was on Dapagliflozin 10 mg daily with blood glucose 240 mg/dL at presentation. Lab parameters are shown in Table 1. Course in ICU: All patients received the standard treatment of DKA. 27 % had AKI and 27% had Acute on CKD. ICU mortality was 36 % with definite alternative causes identified for death. Conclusions: Infections are the most important cause of precipitating events for DKA. Co-morbidities and Complications decide the outcome and early recognition and standard treatment and ICU care are important in critically ill. Disclosure C.R: None. B.N.Jami: None. A.Suresh: None. A.J.Mangaly: None.

Beyond Alcohol and Gallstones: Uncommon Causes of Pancreatitis

Pancreatitis is a major cause of hospital admissions with significant associated morbidity and mortality. Global incidence rates have continued to increase over the last several decades with United States leading the Western world. The most common causes include gallstones for acute pancreatitis and alcohol abuse for both chronic and acute pancreatitis; these are well described in the literature and not infrequently encountered in the day-to-day practice of radiology. Several uncommon pancreatitis causes have unique characteristic patient demographics, clinical presentations, and imaging findings. The unique features relevant to the practice of radiology are discussed for autoimmune pancreatitis, groove pancreatitis, tropical pancreatitis, hereditary pancreatitis, and pancreatic adenocarcinoma presenting as acute pancreatitis with companion cases. The differentiating features of these uncommon causes are emphasized to arrive at a diagnosis. Should imaging remain equivocal, the next steps necessary to arrive at a diagnosis are reviewed. Understanding the various presentations of acute and chronic pancreatitis, both uncommon and common causes are of utmost importance for the practicing radiologist in facilitating management of patient care.

Coexistence of acute pancreatitis and an obstructing upper ureteral calculus: does a calculus cause pancreatitis? a case report.

A 36-year-old male patient presented with epigastric, and right loin pain with decreased urine output for 3 days. On physical examination, he had central abdominal and right flank tenderness. An abdominal ultrasound showed mild to moderate ascites, a hyperechoic pancreas, a small (26×77mm) left kidney with increased echogenicity, right renal hypertrophy with moderate hydronephrosis, and a dilated upper ureter due to a 10mm obstructing stone with a perirenal fluid collection. The diagnosis of acute pancreatitis with an obstructing right upper ureteric stone was established. Under spinal anesthesia, an emergency ureteroscopy with laser fragmentation of the stone was performed, and a JJ stent was inserted. He developed postobstructive diuresis and his renal function was improved with a rapid decline of pancreatic enzymes as well. Two theories explain the presentation of acute pancreatitis by ureteral obstruction. First, the obstructed severe hydronephrotic kidney compresses the duodenum and head of the pancreas, obstructing the distal part of the common bile duct and triggering the elevation of pancreatic duct pressure, bile reflux, trypsin activation, and pancreatic autodigestion. The second theory states that acute pancreatitis develops when urine is extravasated from an obstructed kidney into the adjacent tissues, irritating the uncinate process of the pancreas. Although mentioning ureteral obstruction as a cause of pancreatitis is scarce, the clinician should be aware that in each case of ureteral obstruction, the emergence of acute pancreatitis is a possible complication.

A Case of Groove Pancreatitis Presenting with Intermittent Gastric Outlet Obstruction

A Case of Groove Pancreatitis Presenting with Intermittent Gastric Outlet Obstruction

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK.

Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.