Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis

Colonic complications, including colopancreatic fistulas (CPFs), are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Endoscopic sphincterotomy (ES) may not alter the natural history of idiopathic recurrent acute pancreatitis (IRAP)

Pancreatology ◽

10.1016/j.pan.2016.07.009 ◽

2016 ◽

Vol 16 (5) ◽

pp. 770-777 ◽

Cited By ~ 7

Author(s):

Rohit Das ◽

Bridger Clarke ◽

Gong Tang ◽

Georgios I. Papachristou ◽

David C. Whitcomb ◽

...

Keyword(s):

Acute Pancreatitis ◽

Natural History ◽

Endoscopic Sphincterotomy ◽

Recurrent Acute Pancreatitis ◽

History Of

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CAPD and Pancreatitis: No Connection

Peritoneal Dialysis International ◽

10.1177/089686089201200308 ◽

1992 ◽

Vol 12 (3) ◽

pp. 309-316 ◽

Cited By ~ 33

Author(s):

Amit Gupta ◽

Zheng Vuan ◽

Elias V. Balaskas ◽

Ramesh Khanna ◽

Dimitrios G. Oreopoulos

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Pancreatic Secretory Trypsin Inhibitor ◽

Serum Lipase ◽

High Index Of Suspicion ◽

Acute And Chronic Pancreatitis ◽

Symptoms And Signs ◽

Capd Patient ◽

Uncommon Complication

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.

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347 Endoscopic Sphincterotomy (ES) May Not Alter the Natural History of Idiopathic Recurrent Acute Pancreatitis (IRAP)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.082 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB142

Author(s):

Rohit Das ◽

Bridger Clarke ◽

Gong Tang ◽

Georgios I. Papachristou ◽

David C. Whitcomb ◽

...

Keyword(s):

Acute Pancreatitis ◽

Natural History ◽

Endoscopic Sphincterotomy ◽

Recurrent Acute Pancreatitis ◽

History Of

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Moderate Hypertriglyceridemia Causing Recurrent Pancreatitis: A Case Report and the Literature Review

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/8714390 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Vijay Gayam ◽

Amrendra Kumar Mandal ◽

Pavani Garlapati ◽

Mazin Khalid ◽

Arshpal Gill ◽

...

Keyword(s):

Acute Pancreatitis ◽

Insulin Infusion ◽

Term Treatment ◽

Recurrent Acute Pancreatitis ◽

Nasogastric Feeding ◽

Long Term Treatment ◽

History Of ◽

Laboratory Investigations ◽

Continuous Insulin Infusion

Recurrent acute pancreatitis secondary to hypertriglyceridemia (HTG) with levels below 1000 mg/dL has been rarely reported in the literature. HTG is the third most common cause of acute pancreatitis and has been established in the literature as a risk factor when levels are greater than 1000 mg/dL. A 43-year-old patient presented to the hospital with severe epigastric abdominal pain. Initial laboratory investigations were significant for a lipase level of 4143 U/L and a triglyceride level of 600 mg/dL. Computed tomography (CT) of the abdomen showed diffuse enlargement of the pancreas consistent with pancreatitis. A diagnosis of severe acute pancreatitis secondary to high triglycerides was made based on the revised Atlanta classification 2012. The patient was initially managed with intravenous boluses of normal saline followed by continuous insulin infusion. Diabetic Ketoacidosis (DKA) was ruled out due to a past medical history of diabetes. Her clinical course was complicated by acute respiratory distress syndrome requiring intubation and mechanical ventilation. During the course, she improved symptomatically and was extubated. She was started on nasogastric feeding initially and subsequently switched to oral diet as tolerated. After initial management of HTG with insulin infusion, oral gemfibrozil was started for long-term treatment of HTG. Emerging literature implicates HTG as an independent indicator of poor prognosis in acute pancreatitis (AP). Despite the paucity of data, the risk of developing AP must be considered even at triglyceride levels lower than 1000 mg/dL.

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Eosinophilic Pancreatitis: A Rare Cause of Recurrent Acute Pancreatitis

Case Reports in Gastroenterology ◽

10.1159/000457788 ◽

2017 ◽

Vol 11 (1) ◽

pp. 120-126 ◽

Cited By ~ 4

Author(s):

Jennifer Reppucci ◽

Michael Chang ◽

Steven Hughes ◽

Xiuli Liu

Keyword(s):

Acute Pancreatitis ◽

Immunoglobulin E ◽

Elevated Serum ◽

Peripheral Eosinophilia ◽

Rare Form ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Systemic Manifestations ◽

Inflammatory Infiltrates ◽

Pseudocyst Formation

Eosinophilic pancreatitis is a rare form of recurrent acute pancreatitis that demonstrates distinct histologic features, including diffuse, periductal, acinar, and septal inflammatory infiltrates comprised of a pure or predominant population of eosinophils, eosinophilic phlebitis and arteritis, and localized eosinophilic infiltrates with pseudocyst formation. It is associated with elevated serum immunoglobulin E levels, an elevated eosinophil count with systemic manifestations, and eosinophilic infiltrates in other organs of the gastrointestinal tract. We present a case of eosinophilic pancreatitis in a 44-year-old man who was diagnosed after pancreatic resection for recurrent bouts of acute pancreatitis. While the gross and histologic evaluations matched other reported cases of eosinophilic pancreatitis, our patient had only minimal peripheral eosinophilia, no reported history of symptoms related to elevated eosinophilia or immunoglobulin E, and only mild eosinophilic infiltrates in his gallbladder.

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Risk of acute atherosclerotic cardiovascular disease in patients with acute and chronic pancreatitis

Scientific Reports ◽

10.1038/s41598-021-99915-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Li-Chin Sung ◽

Chuen-Chau Chang ◽

Chao-Shun Lin ◽

Chun-Chieh Yeh ◽

Yih-Giun Cherng ◽

...

Keyword(s):

Cardiovascular Disease ◽

Acute Pancreatitis ◽

Liver Cirrhosis ◽

Chronic Pancreatitis ◽

Control Group ◽

Atherosclerotic Cardiovascular Disease ◽

Research Database ◽

Increased Risk ◽

History Of ◽

Acute And Chronic Pancreatitis

AbstractThe association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

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Acute Recurrent Pancreatitis

Canadian Journal of Gastroenterology ◽

10.1155/2003/781237 ◽

2003 ◽

Vol 17 (6) ◽

pp. 381-383 ◽

Cited By ~ 9

Author(s):

Glen A Lehman

Keyword(s):

Acute Pancreatitis ◽

Endoscopic Sphincterotomy ◽

Microscopic Analysis ◽

Sphincter Of Oddi ◽

Recurrent Pancreatitis ◽

Endoscopic Retrograde ◽

Recurrent Acute Pancreatitis ◽

Idiopathic Pancreatitis ◽

Minor Papilla ◽

The Common

History, physical examination, simple laboratory and radiological tests, and endoscopic retrograde cholangiopancreatography (ERCP) are able to establish the cause of recurrent acute pancreatitis in 70% to 90% of patients. Dysfunction of the biliary and/or pancreatic sphincter, as identified by sphincter of Oddi manometry, accounts for the majority of the remaining cases. The diagnosis may be missed if the pancreatic sphincter is not evaluated. Pancreas divisum is a prevalent congenital abnormality that is usually innocuous but can lead to recurrent attacks of acute pancreatitis or abdominal pain. In select cases, endoscopic sphincterotomy of the minor papilla can provide relief of symptoms and prevent further attacks. A small proportion of patients with idiopathic pancreatitis have tiny stones in the common bile duct (microlithiasis). Crystals can be visualized during microscopic analysis of bile that is aspirated at the time of ERCP. Neoplasia is a rare cause of pancreatitis, and the diagnosis can usually be established by computerized tomography or ERCP. A wide variety of medications can also cause recurrent pancreatitis. ERCP, sphincter of Oddi manometry, and microscopy of aspirated bile should be undertaken in patients with recurrent pancreatitis in whom the diagnosis is not obvious.

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Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

Clinical Medicine Insights Gastroenterology ◽

10.4137/cgast.s13531 ◽

2014 ◽

Vol 7 ◽

pp. CGast.S13531 ◽

Cited By ~ 1

Author(s):

Vincenzo Neri ◽

Francesco Lapolla ◽

Alessandra Di Lascia ◽

Libero Luca Giambavicchio

Keyword(s):

Acute Pancreatitis ◽

Sphincter Of Oddi ◽

Diagnostic Process ◽

Unknown Etiology ◽

Sphincter Of Oddi Dysfunction ◽

Endoscopic Retrograde ◽

Recurrent Acute Pancreatitis ◽

Therapeutic Program ◽

Oddi Dysfunction

Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP), often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs), 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES) in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

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