Rare Case Of Acute Pancreatitis Research Articles

Unexpected culprit of acute pancreatitis – adult cow's milk allergy: A case report

The prevalence of food allergies has been on the rise recently, manifesting in various systemic symptoms. This report presents a rare case of acute pancreatitis in an adult triggered by cow's milk allergy. Although few reports exist linking different food allergens to pancreatitis, this case underscores the importance of considering food allergies in the differential diagnosis of gastrointestinal disorders, beyond typical symptoms like urticaria, pruritus, vomiting, and diarrhea. Allergy patients presenting with only gastrointestinal symptoms may be misdiagnosed as having food intolerances such as lactose intolerance.

ACUTE PANCREATITIS REVEALING MAJOR HYPERTRIGLYCERIDEMIA

Objective: Severe hypertriglyceridemia is a common risk factor for acute pancreatitis and atherosclerotic vascular disease. Our aim was to report a rare case of acute pancreatitis due to major hypertriglyceridemia. Design and method: We report a case of acute pancreatitis revealing major hypertriglyceridemia. Results: A 53-year-old man, was hospitalized in May 2022 in endocrinology departement with abdominal pain, nausea,vomiting and alteration of general condition. History: high blood pressure, type 2 diabetes, alcohol consumption and family history of high blood pressure, type 2 diabetes, dyslipidemia. Clinical examination showed defense on palapation in epigastrium and right flank. Biochemical analyses were as follows: hypertriglyceridemia at 76.42 mmol/L associated with hypercholesterolemia at 17.58 mmol/L, LDL-C = 2.25 mmol/L, HDL-C = 2.12 mmol/L, hyperglycemia = 10.62 mmol/L, HBA1C = 8.1%, Lipasemia = 281 UI/L. Abdominal ultrasound did not show lithiasis, abdominal CT scan revealed pancreatitis. The diagnosis of acute pancreatitis due to major hypertriglyceridemia was made. The patient was treated by plasmapheresis and triglyceride level was reduced to 2.5 mmol/L. The lipidogram showed an isolated elevation of VLDL and defined hypertriglyceridemia as Familial hyperlipoproteinemia type 4. Conclusions: Familial hyperlipoproteinemia type 4 syndrome is an uncommon condition. Acute pancreatitis secondary to severe hypertriglyceridemia is a condition with a high risk of mortality which requires prompt clinical suspicion and treatment.

A rare case of acute pancreatitis due to scrub typhus: A case report

A rare case of acute pancreatitis due to scrub typhus: A case report

S1905 A Rare Case of Acute Pancreatitis With Normal Lipase

Introduction: Acute pancreatitis (AP) is an inflammatory disease of the pancreas that usually presents with epigastric pain radiating to the back. AP is a critical condition that can lead to multi-organ failure if not diagnosed early. It is diagnosed with 2 of the following: characteristic abdominal pain, imaging consistent with acute pancreatitis, and lipase levels greater than 3 times the upper limit of normal. The negative predictive value of lipase for diagnosing acute pancreatitis is between 94% and 100%. We present a rare case of acute pancreatitis with normal serum lipase levels. Our findings highlight the vital utility of imaging for diagnosing acute pancreatitis in the setting of normal lipase levels. Case Description/Methods: An 80-year-old female presented with a 1-day history of epigastric pain radiating to her back associated with nausea, vomiting, and loss of appetite. Her past medical history was significant for hypertension, NIDDM II, and atrial fibrillation. She had no recent medication changes and took amlodipine, metformin, metoprolol, and apixaban. Previous surgeries included cholecystectomy and appendectomy. She abstained from alcohol, tobacco, or recreational drug use. She reported abdominal trauma from bicycle collision one week prior to arrival. Vital signs were remarkable for T 101.2 F. She did not appear in acute distress. Her physical exam was remarkable for epigastric tenderness on palpation. Murphy, Cullen, and Grey-Turner signs were absent. Laboratory evaluation revealed WBC 12.8 k/uL, lipase 29 U/L, amylase 52 U/L, AST 13 U/L, ALT 21 U/L, ALP 58 U/L (Table). Lipid profile and EtOH levels were within normal limits. CT of the abdomen and pelvis revealed interstitial edematous pancreatitis (Figure). She was started on aggressive intravenous fluid resuscitation, metoclopramide for nausea, and intravenous acetaminophen for pain. Her abdominal pain progressively resolved, and she tolerated a full diet by day 3. Discussion: AP is a critical condition that requires early diagnosis. The negative predictive value of elevated lipase levels for diagnosing AP ranges from 94% to 100%. Our patient was diagnosed with acute pancreatitis due to trauma in the setting of normal lipase levels. We demonstrate the utility of imaging in diagnosing acute pancreatitis in the setting of normal serum lipase levels.Figure 1.: CT scan of the abdomen revealed peripancreatic fat stranding and interstitial edema consistent with findings of pancreatitis. Table 1. - Laboratory trends are displayed here. Lipase remained within normal limits through the 4 days measured. Admission Day 1 Day 2 Day 3 Day 4 Normal Range Hemoglobin 8.8 7.8 9.3 8.6 9.0 12.0 - 15.0 g/dL WBC 12.8 7.4 5.9 5.7 6.2 3.4 - 11.0 10*3/uL Amylase 52 39 29 - 103 U/L Lipase 29 12 13 - 60 U/L Calcium 8.9 8.1 8.9 8.8 8.4 8.4 - 10.2 mg/dL Alkaline Phosphatase 58 44 46 59 54 40 - 129 U/L ALT 21 16 29 17 11 10 - 50 U/L AST 13 10 14 12 16 13 - 39 U/L

S1595 A Curious Case of COVID-19-Induced Acute Severe Pancreatitis

Introduction: The COVID-19 virus causes a wide range of lung diseases. It has also been proven to affect other organ systems. Acute pancreatitis is defined as inflammation of the pancreas and has varied etiologies. SARS-CoV2 affects the pancreas by direct binding to ACE2 receptors and stimulation of an inflammatory cytokine storm. Here, we present a rare case of acute pancreatitis induced by COVID-19 in an healthy individual. Case Description/Methods: 35 y.o male with no medical history presented with altered mental status. He was noted to be hypothermic, hypotensive, and tachypneic. Labs revealed, elevated anion gap metabolic acidosis, leukocytosis, ketonuria with elevated blood glucose of 1056mg/dL. Treatment for DKA was started with insulin drip and IV fluids. Patient tested positive for COVID-19, however had no respiratory symptoms. HbA1c was 18. On the 4th day of admission, he developed emesis and epigastric abdominal pain. A CT abdomen revealed features of acute pancreatitis, no evidence of necrosis or fluid collection. Lipase was elevated to 1399. He began spiking intermittent fevers, was initiated on systemic antibiotic therapy. A workup for various etiologies of pancreatitis was performed. A thorough work-up and medication reconciliation ruled out many etiologies of pancreatitis, including alcohol, medications, triglycerides, biliary, and autoimmune pathologies. Abdominal pain continued with development of abdominal distention, therefore, TPN was initiated. Inflammatory markers were elevated. Patient was managed with bowel rest, IV fluids and pain control. A repeat CT abdomen showed persistent ongoing inflammation in the abdomen secondary to pancreatitis and ongoing retroperitoneal fluid. This patient presented with DKA, new onset diabetes mellitus and development of acute pancreatitis. While common causes were ruled out, one diagnosis to consider is COVID-19 induced acute pancreatitis. The absence of other causes, this remains a diagnosis of exclusion. Discussion: Etiologies of acute pancreatitis include alcohol use and gallstone disease. Diagnosis requires 2/3: abdominal pain, imaging of pancreatic inflammation, and lipase elevation. Several viruses have been implicated in the etiology of acute pancreatitis, SARS-CoV-2 also has its significance. Understanding of clinical manifestations of COVID-19 continues to evolve, this case demonstrates that SARS-CoV-2 can precipitate pancreatitis. It is important that clinicians remain cognizant of COVID-19 being a cause for acute pancreatitis.

A rare case of acute pancreatitis: a diagnostic conundrum and unusual complications

A 63-year-old man with a history of recurrent idiopathic acute pancreatitis (AP) was admitted to our surgical ward due to severe abdominal pain. He denied chronic excessive alcohol use. Other typical causes of AP, such as gallstones, hypertriglyceridemia, and trauma, were ruled out. After considering all possible etiologies, the most likely factor producing AP was medication that had been administered to him two weeks before the very first episode of the disease. Medication should always be considered as a possible trigger of AP, especially if the first episode occurs shortly after drug administration and the etiology is unclear. During patient’s hospitalization, laboratory reports revealed significant fluctuations in the serum levels of pancreatic enzymes, which can be attributed to recurrent bacteriemia. After the 30-day period of hospitalization and long-lasting antibiotic therapy, he was discharged in a good condition with normal levels of serum pancreatic enzymes.

A rare case of acute pancreatitis: a diagnostic conundrum and unusual complications.

A 63-year-old man with a history of recurrent idiopathic acute pancreatitis (AP) was admitted to our surgical ward due to severe abdominal pain. He denied chronic excessive alcohol use. Other typical causes of AP, such as gallstones, hypertriglyceridemia, and trauma, were ruled out. After considering all possible etiologies, the most likely factor producing AP was medication that had been administered to him two weeks before the very first episode of the disease. Medication should always be considered as a possible trigger of AP, especially if the first episode occurs shortly after drug administration and the etiology is unclear. During patient's hospitalization, laboratory reports revealed significant fluctuations in the serum levels of pancreatic enzymes, which can be attributed to recurrent bacteremia. After the 30-day period of hospitalization and long-lasting antibiotic therapy, he was discharged in a good condition with normal levels of serum pancreatic enzymes.

3038 A Rare Case of Pancreatitis Due to Paraesophageal Hernia

INTRODUCTION: Pancreratitis due toWe present a rare case of acute pancreatitis due to a large paraesophageal hernia who presented to the emergency department with chief compliant of epigastric pain and dysphagia. CASE DESCRIPTION/METHODS: A 65-year- old female presented to our emergency department due to progressively worsening epigastric pain. The pain sharp, intermittent and moderate in severity and radiated to her back associated with nausea and vomiting. She denied fever, shortness of breath, or chest pain. A review of systems was otherwise negative. Physical examination including vital signs was unremarkable with the exception of mild epigastric tenderness on palpation. Seven years prior to admission, patient underwent laparoscopic cholecystectomy for gallstones pancreatitis. Laboratory data was unremarkable. Although her serum lipase was within normal limits (114 U/L), her history and physical were concerning for pancreatic pathology. Therefore, CT scan of the abdomen was obtained and demonstrated trace inflammatory fluid around the pancreatic uncinate process, consistent with mild pancreatitis. Additionally, a massive hiatal hernia was noted causing mild atelectasis in the lung bases. The patient was admitted to our facility and was treated for the presumptive diagnosis of recurrent pancreatitis. Of interest, five months prior to this admission, the patient had presented to the ED with similar symptoms. CT imaging at that time had also demonstrated large paraesophageal hernia. She was evaluated by our general surgery service and was deemed not to be a candidate for surgical intervention. Due to the recurrent nature of her symptoms, she subsequently underwent esophagogastroduodenoscopy during which the paraesophageal hernia was identified with a large amount of food and fluid within it. Thusly she was reevaluated by our general surgery team and ultimately underwent reduction of her stomach, paraesophageal hernia repair, and gastrostomy tube insertion. Patient did well post-operatively with no complication. Patient was discharged to rehab 7 days after surgery. DISCUSSION: We believe that the patient's recurrent symptoms were the result of progressive enlargement of the paraesophageal hernia that manifested as a gastric volvulus. There are few cases of pancreatitis due to paraesophageal hernia leading pancreatic herniation1. Serum lipase measurements that are below normal limits can indicate chronic pancreatitis2. Few cases of pancreatitis were reported with low lipase.2

1276 Acute Pancreatitis Causing Multiple Aortic Thrombi and Multi-Organ Infarcts

INTRODUCTION: There have not been many case reports of acute pancreatitis causing aortic thrombi. In this vignette we illustrate this rare but noteworthy clinical scenario. CASE DESCRIPTION/METHODS: A 44-year-old homeless man with a history of chronic pancreatitis and alcoholism presented with acute, sharp, diffuse abdominal pain. Vital signs were notable for hypotension and tachycardia. Abdominal examination revealed a diffusely tender abdomen with guarding and rigidity. Neurological examination revealed bilateral upper extremity weakness. White blood cell count, lipase, ESR, CRP, and D-dimer were all markedly elevated A CT abdomen revealed acute pancreatitis with diffuse acute multiple thrombi in the aorta with hepatic, splenic, bowel, and bilateral renal infarcts. There was diffuse ascites of the abdomen and pelvis with bilateral pleural effusions. Cervical MRI revealed C4-C6 cord infarct with diffusely abnormal signal. Brain MRI revealed two acute ischemic infarcts in the right occipital lobe. CTA chest revealed multiple large exophytic thrombi in the descending aorta with no evidence of pulmonary embolism. Duplex ultrasound of all extremities and echocardiogram with contrast were non-revealingHypercoagulability studies revealed mildly decreased factor II, antithrombin III, and protein C levels. Anticoagulation was started with IV heparin and later switched to a direct oral anticoagulant. Paracentesis revealed pancreatic ascites. The patient's abdominal pain resolved and he was transferred to a higher tertiary care center where he was found to have a pancreatic duct leak requiring stenting. DISCUSSION: There are only a few reports in the literature of acute pancreatitis causing aortic thrombosis. The pathophysiology remains unclear. However, there are a few hypotheses. First, proteolytic enzymes released in the setting of acute pancreatitis cause direct injury to the aortic wall, resulting in a nidus for mural thrombus formation. Second, trypsin released during acute pancreatitis causes the activation of several thrombogenic factors such as platelets and fibrinogens. Lastly, hypovolemia caused by acute pancreatitis increases the risk of vascular stasis and vasospasm. In conclusion, this is a rare case of acute pancreatitis complicated by multiple aortic thrombi and multi-organ infarcts in the setting of a mild coagulation disorder. The patient responded well to supportive measures for acute pancreatitis and direct oral anticoagulants thereafter.

A rare case of acute pancreatitis due to roundworm infestation

Roundworm or Ascaris lumbricoides is one of the most common parasitic infestations of the human gastrointestinal tract occurring particularly in tropical and temperate countries having hot and humid conditions. On rare occasions, it may invade the biliary tract and the main pancreatic duct causing obstruction and leading to acute pancreatitis. Here, a similar case is presented of a patient who presented with symptoms of acute abdomen and vomiting, with imaging suggestive of roundworm infestation in the main pancreatic duct and who later improved with supportive care.

Acute Pancreatitis as a Complication of Sickle Cell Anaemia

A common cause of abdominal pain is acute pancreatitis, with the majority of cases being attributed to gallstones and excess alcohol. Sickle cell anaemia (SCA) is an autosomal recessive disease causing the production of abnormal haemoglobin. Physiological changes can lead to vaso-occlusion in sickle cell anaemia. Cholelithiasis is frequently seen in patients with SCA and complications from this can increase patient morbidity. We present a rare case of acute pancreatitis inducing a vaso-occlusive crisis.

A Rare Cause of Acute Pancreatitis

Energy Drinks (EDs) have become increasingly popular in recent years, but their safety profile is less well known. Case reports about the adverse effects of EDs are emerging Some known gastrointestinal adverse effects are dyspepsia, diarrhea and heart burn, all of which have been linked to excessive caffeine content. We report a rare case of acute pancreatitis from consumption of ED. A 27-year-old male with history of cholecystitis s/p cholecystectomy presented to Emergency department with epigastric abdominal pain, nausea and vomiting for one day. Of note patient had presented with acute pancreatitis (AP) 1 month prior when no clear etiology was found. History was negative for alcohol, recreational drug use, trauma or family history of pancreatitis but positive for excessive consumption of EDs up to 6 cans per day. Physical examination was unremarkable except for epigastric tenderness. Labs were significant for lipase 2,375 U/L, aspartate aminotransferase 121 U/L, alanine aminotransferase 180 U/L and alkaline phosphatase 51 U/L. BMP, Lipid panel, Immunoglobulin G4 and urine toxicology were unremarkable. Computed tomography abdomen revealed common bile duct dilation of 10 mm but no choledocolithiasis (figure 1 and 2). Further work up with magnetic resonance cholangiopancreatography revealed no obstruction, microlithiasis or ampullary abnormality (figure 3). Genetic mutations CFTR and PRSS were also negative. At this point etiology was thought to be excessive consumption of EDs. Use of EDs to improve stamina, performance and alertness has increased significantly in past two decades. To our knowledge there is only one more case report of EDs induced AP. This is a rare case showing association between acute pancreatitis and consumption of EDs. The mechanism how EDs cause pancreatitis is unclear and further research is warranted.

A Rare Case of Acute Pancreatitis in a Patient with Myotonic Dystrophy

A Rare Case of Acute Pancreatitis in a Patient with Myotonic Dystrophy

A Rare Case of Acute Pancreatitis Caused by Hepatitis B Virus Underwent Deceased Donor Liver Transplantation

A Rare Case of Acute Pancreatitis Caused by Hepatitis B Virus Underwent Deceased Donor Liver Transplantation

Acute Pancreatitis Caused By Mushroom Poisoning: A Report of Two Cases.

Of the more than 5000 species of mushrooms known, 100 types are toxic and approximately 10% of these toxic types can cause fatal toxicity. A type of mushroom called Amanita phalloides is responsible for 95% of toxic mushroom poisonings. In this article, we report 2 cases of mushroom poisonings caused by Lactarius volemus, known as Tirmit by the local people. The patient and his wife were admitted to the emergency room with abdominal pain, nausea, and vomiting 20 hours after consuming Lactarius volemus, an edible type of mushroom. The patients reported that they had been collecting this mushroom from the mountains and eating them for several years but had never developed any clinicopathology to date. Further examination of the patients revealed a very rare case of acute pancreatitis due to mushroom intoxication. The male patient was admitted to the intensive care unit while his wife was followed in the internal medicine service, because of her relative mild clinical symptoms. Both patients recovered without sequelae and were discharged. In this article, we aimed to emphasize that gastrointestinal symptoms are often observed in mushroom intoxications and can be confused with acute pancreatitis, thus leading to misdiagnosis of patients. Early diagnosis and appropriate treatment can improve patients’ prognosis and prevent the development of complications.

Intrapancreatic pseudoaneurysmal rupture in a case of pancreatitis

Thrombosis & pseudoaneurysm formation are recognised vascular complications ofpancreatitis, occurring in 25% of acute pancreatitis cases.1 Though both were reportedindividually, their occurrence together in the same patient is rare. We report a rare case ofacute pancreatitis complicated by pseudocyst formation, portal vein thrombosis andpseudoaneurysm formation in the intrapancreatic vessels, with subsequent rupture of thepseudoaneurysm into the pseudocyst following heparin administration for portal veinthrombus.

Pancreatitis by Compression

Diverticula are a rare cause of pancreatitis. We present a case of acute pancreatitis secondary to compression from a periampullary duodenal diverticulum (PAD). A 38-year-old male presented with acute epigastric abdominal pain. He denied other symptoms and had no history of alcohol intake, trauma, or taking any medications. He was afebrile and hemodynamically stable. On exam, his abdomen was tender to palpation in the epigastrium. His labs were notable for a WBC 11.5 k/mm3, lipase 5,410 IU/L, AST 87 IU/L, ALT 72 IU/L, ALP 126 IU/L, total bilirubin 0.5mg/dL, normal triglycerides and calcium levels. He was admitted with suspected biliary pancreatitis and medical management was initiated with intravenous fluids, bowel rest, and pain control. His liver enzymes subsequently increased to an AST 469 IU/L, ALT 503 IU/L and total bilirubin 1.4 mg/dL. An abdominal ultrasound done prior to admission for similar symptoms was negative for gallbladder stones or sludge. Computed Tomography Scan showed mild common bile duct and pancreatic duct dilatation with an edematous pancreatic head consistent with pancreatitis. An Endoscopic Retrograde Cholangiopancreatography showed a large diverticulum with food impaction obscuring the major duodenal papilla. Some food particles were removed from the diverticulum using a grasping snare and a Roth net. Due to remnant food debris, the ampulla could not be located to allow for cannulation within the large diverticulum. Magnetic Resonance Cholangiopancreatography revealed an enlarged pancreatic head with a large 3cm duodenal diverticulum compressing its inferior portion at the ampulla of Vater with no evidence of biliary stones. The patient's symptoms and laboratory abnormalities improved after ERCP, and he was discharged with surgical follow-up for possible intervention in event of recurrent pancreatitis attacks. Duodenal diverticula rarely cause pancreatitis, but should be kept in mind as a potential etiology. About 70-75% of duodenal diverticula occur in the periampullary region. Factors that contribute to the development of these diverticula include age, weakening of intestinal smooth muscles, and increased intraduodenal pressure. Mechanical pressure from the diverticulum and diverticular inflammation from narrowing at the duodenal papilla leads to complications of PAD. Surgical intervention is not indicated for asymptomatic patients. Patients who are symptomatic may necessitate surgical or endoscopic intervention, such as sphincterotomy. We present a rare case of acute pancreatitis caused by compression from a periampullary duodenal diverticulum.Figure 1Figure 2Figure 3

A Rare Case of Acute Pancreatitis From an Ulcer at the Duodenal Papilla

Background: Acute pancreatitis is a fairly common diagnosis accounting for significant amount of mortality and morbidity. Rarely peptic ulcer can cause acute pancreatitis if the ulcer bed is above the pancreas. However it is extremely rare to have acute pancreatitis with a peptic ulcer present in the diverticulum surrounding the duodenal papilla. Here we present a case of an elderly woman who presented with upper gastrointestinal bleeding and acute pancreatitis. Case Discussion: A 93-year-old female with a past medical history of peripheral vascular disease, cerebrovascular accident, atrial fibrillation not on anticoagulation, GERD presents with a few episodes of having bowel movements with bright red blood per rectum. Patient denied alcohol use. Physical examination was unremarkable. Hemoglobin was 9mg/dL which was her baseline, and all over value were with in normal limits. On the first night of her admission she developed severe abdominal pain and hematemesis. An emergent CT scan of the abdomen with contrast showed a hyperdense probable dilated duodenum with fluid and debris in the lumen. Amylase and Lipase were elevated to 1000 units/L and 1600 units/L respectively. White blood cell count and liver function panel were unchanged from admission. An esophagoduodenoscopy (EGD) done at that time showed a large adhering clot in the descending duodenum preventing further visualization. Due to the limited visualization on the earlier EGD, a repeat EGD was done on the following day, which showed two large diverticulum along medial wall of descending duodenum. Both of them showed signs of ulceration and visible vessels inside the diverticulum. One of the ulcer was encircling the duodenal papilla and on clear visualization the whole papilla seemed slightly edematous. The patients abdominal pain improved significantly by day 2 and the pancreatic enzymes started trending down. Other pertinent laboratory studies included a normal triglyceride level. Her condition gradually improved in the subsequent days and she was discharged to rehabilitation center. Discussion: Our case is unique in the way that pancreatitis was caused by the edema of the duodenal papilla and resulting obstruction of the pancreatic duct. This obstruction was so transient and non contributing once the duodenal ulcer is cleared up by endoscopy. Clinicians should be aware of these unusual causes of acute pancreatitis in those the regular etiologies don't fit and should aid in early reversal to change the impact of morbidity/mortality of acute pancreatitis.Figure 1

Acute pancreatitis as the initial presentation of systematic lupus erythematosus.

Systematic lupus erythematosus (SLE) is a multisystem disease, including the gastrointestinal system in about half of SLE patients. As a rare complication of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis as the initial presentation with later diagnosis of SLE.

Acute pancreatitis and development of pancreatic pseudo cyst after extra corporeal shock wave lithotripsy to a left renal calculus: A rare case with review of literature

Extracorporeal shock wave lithotripsy (SWL) is considered the standard of care for the treatment of small upper ureteric and renal calculi. A few centers have extended its use to the treatment of bile duct calculi and pancreatic calculi. The complication rates with SWL are low, resulting in its wide spread acceptance and usage. However, some of the serious complications reported in 1% of patients include acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of aortic aneurysm and intracranial hemorrhage. To our knowledge, only six cases of acute pancreatitis or necrotizing pancreatitis following SWL have been documented in the literature. Herein, we report a rare case of acute pancreatitis and formation of a pseudo cyst following SWL for left renal pelvic calculus.