Steroid-induced Pancreatitis Research Articles

Apposing the Average Age: Lumen-Apposing Metal Stent Placement in a 3-Year-Old

Pancreatic Pseudocysts (PPs) complicate 10-20% of pancreatitis, the majority of which are asymptomatic and do not require drainage. When drainage is indicated, PPs have conventionally been managed surgically. Since surgery is associated with high complication rates (35%) and mortality (10%), PPs have increasingly been managed with less invasive techniques. Percutaneous drainage and indwelling catheters have both been associated with high recurrence rates. Therefore, endoscopic ultrasound-guided transmural drainage has become the best modality to drain peripancreatic fluid collections (PFCs). Most cases of PFC drainage in the literature involve adults. We describe a 3 year old with a PFC that was drained using a lumen-apposing metal stent (LAMS). A 3 year old female with history of cerebellar atrophy in a persistent vegetative state s/p ventriculoperitoneal shunt, chronic respiratory failure s/p tracheostomy placement and on home ventilator, G-tube dependent for nutrition, seizure disorder, steroid-induced pancreatitis complicated by PFC, was admitted with septic shock secondary to pneumonia. After initial improvement, she was found to have recurrent septic shock 3 weeks into her hospitalization due to infected PFC. Despite IV Meropenem and Fluconazole, she had persistent fevers in the setting of: negative blood and urine cultures, normal Chest X-Ray, and remained on her baseline ventilator settings. After attempted percutaneous drainage by Interventional Radiology, the decision was made to pursue endoscopic drainage. Endoscopic ultrasound-guided cystgastrostomy was completed on 4th week of admission using a LAMS. Subsequently, the patient's fevers resolved; however, the peripancreatic fluid collection persisted, requiring endoscopic pigtail catheter placement 14 days later. Unfortunately, the patient's sepsis worsened, and the patient's family decided to pursue comfort measures 12 days later. This is a rare case of a LAMS placed in a pediatric patient for drainage of a PFC. One of the challenges faced in the pediatric population is the limited equipment options and the size of the patient. LAMS have rarely been used in pediatric patients without adverse events directly related to stent placement. According to the literature, adult endoscopes and devices can be used safely in children>3 years of age or >15kg in weight. Consideration should be made on a case-by-case basis should LAMS placement be indicated in a young patient.2463_A Figure 1. CT abdomen: Pancreatic Pseudocyst prior to endoscopic intervention.2463_B Figure 2. Endoscopic Image: status post LAMS placement patient's PP did not resolve; hence, pigtail catheter was placed endoscopically within the LAMS.2463_C Figure 3. Endoscopic Ultrasound Image: Peripancreatic Fluid Collection with debris.

Steroid-Induced Pancreatitis

Steroid-Induced Pancreatitis

Steroid-induced pancreatitis: Does it really exist?

The observation that corticosteroids induce or are associated with acute pancreatitis in humans has been emphasized over the past 25 yr (l-20). Two recent reviews of drug-induced pancreatitis (21,22), as well as current textbooks (23,24), cite the evidence that implicates steroids as a cause of pancreatitis. Overlooked, however, in these reviews are many case reports (25-35) and experimental data (33,3639) that suggest exactly the opposite, i.e., corticosteroids may be of benefit in the treatment of severe acute pancreatitis. In this review, we present a critical evaluation of the literature that implicates corticosteroids as a cause of pancreatitis. Our analysis casts doubt on the etiologic association between steroids and pancreatitis and, in fact, suggests that corticosteroids may indeed be useful in the treatment of acute pancreatitis.

Acute Respiratory Distress in a Child After Steroid-Induced Pancreatitis

Acute pancreatitis is a well-known but rare complication of corticosteroid therapy in both children1-3 and adu1ts.4,5 In adults, respiratory insufficiency may follow the onset of acute pancreatitis.6-8 This report describes a child with systemic lupus erythematosus (SLE) in whom acute respiratory distress developed after steroid-induced pancreatitis. CASE REPORT A 12-year-old girl with SLE in remission (maintenance therapy, 60 mg of prednisone on alternate days) was admitted to the University of California Los Angeles Hospital with a one-week history of fever, dysuria, facial rash, and joint pain. A urinary tract infection was detected and the patient was placed on a regimen of antibiotics.

Was It Pancreatitis?

ABSTRACT To the Editor:— The role of adrenal steroid treatment as a cause of was reported by Schrier and Bulger (Steroid-Induced Pancreatitis, 194:564, 1965). The diagnosis of was supported by only two findings: (1) Epigastric and right-upper-quadrant pain which radiated to the back, and (2) One serum amylase determination measuring 284 units/100 cc. Penetrating peptic ulcer as a cause of the hyperamylasemia was excluded by the normal gastrointestinal x-ray films and a lack of symptomatic response to antacids.Notably absent was a report of the abdominal findings at the time of the pain. In a case in which all the findings relative to the pancreatitis could be explained by disease of the biliary tree, no radiographic or chemical studies of biliary function are recorded. There was insufficient evidence to justify a diagnosis of pancreatitis.There was little reason to attribute the elevated serum amylase to prednisone rather than

Steroid-Induced Pancreatitis

THE COMPLICATIONS of therapy with adrenocortical hormones have been reviewed extensively, but the pancreatic abnormalities which occur in association with administration of steroids rarely have been included.¹ A postmortem study by Carone and Liebow²revealed histologic evidence of acute pancreatitis, or peripancreatic fat necrosis, in 16 of 54 patients treated with corticotropin or adrenal steroids. In a control group of 54 patients of comparable age and with similar major diseases, only two had these pathologic changes. The clinical diagnosis of pancreatitis was not made in any of these patients. In 1961 Nelp³reviewed the literature and reported six of his own cases of clinically manifest acute pancreatitis associated with the administration of adrenal steroids. To our knowledge, no additional cases have been reported. In 12 of 14 previously reported instances of symptomatic pancreatitis induced by steroids, the diagnosis was not made until exploratory surgery or autopsy.^3-8

Steroid-induced pancreatitis

Steroid-induced pancreatitis