pancreatitis
Pancreatic Pseudocyst
Submitted by GPH on Mon, 2010-11-29 12:35
Huge Pancreatic Pseudocyst
This is one of the larger pancreatic pseudocysts I have seen. The patient initially presented with a gallstone pancreatitis. ERCP was done and several stones were evacuated from his common bile duct.
The patient was readmitted several weeks later with worsening abdominal pain, fever and diarrhea. While in the hospital the patient developed sepsis and septic shock with multiple organ failure.
The likely source of sepsis - infected pancreatic pseudocyst. A catheter was placed into the fluid collection with more than 800ml of brownish evacuated. The patient started improving.
Drainage of the pancreatic pseudocyst is considered the treatment of choice for unresolving cysts. Surgical drainage is still considered to be the gold standard. Percutaneous or endoscopic drainage has gained popularity in the recent years and, by many reports, is considered as effective as surgical drainage.
Elevated Lipids Causing Acute Pancreatitis
Submitted by RSF on Tue, 2010-02-09 12:09
A young male patient presented to the emergency room with severe diffuse abdominal pain that had been relentless at home. Prior to this, he had no real medical problems. His CT scan showed severe pancreatitis. He was admitted, started on a PCA as well as fluids. He was kept NPO. A work up was started to look at potential etiologies for his pancreatitis. He did not use alcohol. His gallbladder showed some sludge but no definite stones. He was not taking any medications at home. He had no recent travel or scorpion bites. His metabolic panel including electrolytes was all normal. THEN, his lipid panel came back. His triglyceride level was 5880.
Hypertriglyceridemia accounts for only 1.3-3.8% of pancreatitis attacks according to recent medical data. Even then the likelihood of having a triglyceride level over 1000 is rare. It occurs in 1 in 5000 people.
This case raised a question for me: how do we start lowering his triglycerides when he needs to be on bowel rest for his severe pancreatitis? I posed this question to our Gastroenterologist. The answer was quite interesting. He said that just by being NPO the triglyceride level would start to naturally trend down, not to normal, but down to a level where the pancreas would recover. Then we would initiate the oral agents along the a very low fat diet in order to control his levels.
The most fascinating thing was that on hospital day #2 his triglyceride level had already dropped to 2700! The patient started to have a slow resolution of his abdominal discomfort.
Hypertriglyceridemia is a rare but definite cause of pancreatitis and when it hits it certainly does make itself known! The patient said to me "I guess this means no more Big Macs!" I guess so!
