DOI: https://dx.doi.org/10.18203/2349-3933.ijam20222106
Published: 2022-08-24

An interesting case of acute pancreatits

Lakshmipriya Kalidindi, Mohana Linkeshavan, Mahendra Kumar Kalappan, Jagadeesan Mohanan, Kannan Rajendran

Abstract


Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis but it is relatively rare and requires a high level of clinic suspicion. We report a 30 years old male with no co-morbidities who is a non-alcoholic, non-smoker presented with epigastric pain associated with vomiting for two days. His vitals were stable and systemic examination was unremarkable. Serum lipase levels were elevated [7365 U/l (<40 U/l)]. Computed Tomography of the abdomen suggested acute pancreatitis with extensive peri-pancreatic inflammatory changes with no evidence of pancreatic necrosis. Serum triglycerides were found to be elevated (3450 mg/dl). A diagnosis of HTG induced acute pancreatitis was made. During evaluation he was found to be diabetic. He was treated with intravenous fluids, IV insulin infusion, and other supportive measures. He was started on statins, fenofibrate and omega 3 fatty acids. His condition improved and triglyceride levels after two days were in a declining trend and he was discharged on the same. He was currently under follow up and his serum amylase, serum lipase, serum triglycerides were normal. This case report provides insight into rare cause of acute pancreatitis-HTG which if diagnosed at the earliest can be treated promptly.


Keywords


HTG, Acute pancreatitis, IV Insulin

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References


Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 2015;386:85-96.

Xiao AY, Tan ML, Wu LM. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016;1:45-55.

Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. Systematic review of hypertriglyceridemia-induced acute pancreatitis: A more virulent etiology? Pancreatology. 2016;16(4):469-76.

Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36(1):54-62.

Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol. 2018;11(6):441-8.

Havel RJ. Pathogenesis, differentiation and management of hypertriglyceridemia. Adv Intern Med 1969;15:117-54.

Sahu KK, Mishra AK, Lal A. Update on management of hypertriglyceridaemiainduced acute pancreatitis. BMJ Case Rep. 2019;12:e231703.

Navina S, Acharya C, DeLany JP. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:107ra110.

Searles GE, Ooi TC. Underrecognition of chylomicronemia as a cause of acute pancreatitis. CMAJ. 1992;147:1806-8.

Ewald N. Hypertriglyceridemia-induced acute pancreatitis. Clin Lipidol. 2013;8:587-94.

Jain D, Zimmerschied J. Heparin and insulin for hypertriglyceridemia-induced pancreatitis: case report. Sci World J. 2009;9:1230-2.

Click B, Ketchum AM, Turner R. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: a systematic review. Pancreatol Off J Int Assoc Pancreatol. 2015;15:313-20.

Huang C, Liu J, Lu Y. Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: a retrospective study. J Clin Apher. 2016;31(6):571-8.

Liu Q, Prinz RA. Pancreatitis associated with hyperlipidemia and hyperparathyroidism. In: Howard JM, Idezuki Y, Ihse I eds. Surgical diseases of the pancreas, 3rd ed. Baltimore, Williams and Wilkins. 1998:271-80.

Lindgren FT, Jensen LC, Hatch FT. The isolation and quantitative analysis of serum lipoproteins. In: Nelson GJ, ed. Blood lipids and lipoproteins: quantification, composition and metabolism. New York: John Wiley and Sons. 1972;181.

Nilsson-Ehle P. Regulation of lipoprotein lipase: triacylglycerol transport in plasma. In: Carlson LA, Pernow B eds. Metabolic risk factors in ischemic cardiovascular disease. New York, Raven Press. 1982;49.