Insights into Acute Pancreatitis Associated COVID-19: Literature Review

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the lungs, causing respiratory symptoms. However, the infection clearly affects all organ systems including the gastrointestinal system. Acute pancreatitis associated with coronavirus disease 2019 (COVID-19) has been widely reported Recent studies have discussed pancreatic compromise incidentally in asymptomatic patients, or in a form of clinical symptoms such as abdominal pain, nausea, or vomiting, which is further reflected in some cases with abnormal serum lipase and amylase levels It was suggested that upregulation of angiotensin-converting enzyme II cell receptors or inflammatory cytokines play a major role in predisposing pancreatic injury in SARS-CoV-2 positive patients To date, there is insufficient data to establish the causality of acute pancreatitis in SARS-CoV-2 infected cases. In this paper, we organize recent studies conducted to observe the frequency of acute pancreatitis associated with COVID-19 cases while highlighting present hypotheses, predisposing factors, and their effect on the outcome, and point to gaps in our knowledge.

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Acute Pancreatitis: An Atypical Presentation

Case Reports in Gastroenterology ◽

10.1159/000475920 ◽

2017 ◽

Vol 11 (2) ◽

pp. 359-363 ◽

Cited By ~ 1

Author(s):

Omar Nadhem ◽

Omar Salh

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Reports ◽

Case Series ◽

Normal Serum ◽

Intravenous Fluids ◽

Serum Enzyme ◽

Serum Lipase ◽

Upper Abdominal ◽

Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

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Man with epigastric pain and persistently elevated serum lipase

BMJ Case Reports ◽

10.1136/bcr-2019-229208 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229208

Author(s):

Caroline Annette Erika Bachmeier ◽

Adam Morton

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Epigastric Pain ◽

Elevated Serum ◽

Pancreatic Disease ◽

Radiological Assessment ◽

Serum Lipase ◽

Persistent Elevation ◽

Assay Interference ◽

Laboratory Assay

Serum lipase and amylase are commonly requested in individuals presenting with abdominal pain for investigation of acute pancreatitis. Pancreatic hyperenzymaemia is not specific for acute pancreatitis, occurring in many other pancreatic and non-pancreatic conditions. Where persistent elevation of serum lipase and amylase occurs in the absence of a diagnosed cause or evidence of laboratory assay interference, ongoing radiological assessment for pancreatic disease is required for 24 months before a diagnosis of benign pancreatic hyperenzymaemia can be made. We report a case of a 71-year-old man with epigastric pain and elevated serum lipase levels. He was extensively investigated, but no pancreatic disease was detected. He is asymptomatic, but serum lipase levels remain elevated 18 months after his initial presentation.

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Systemic lupus erythematosus-related acute pancreatitis

Lupus ◽

10.1177/0961203320978515 ◽

2020 ◽

Vol 30 (1) ◽

pp. 5-14

Author(s):

Alina Dima ◽

Daniel Vasile Balaban ◽

Ciprian Jurcut ◽

Mariana Jinga

Keyword(s):

Systemic Lupus Erythematosus ◽

Acute Pancreatitis ◽

Abdominal Pain ◽

Plasma Exchange ◽

Lupus Erythematosus ◽

High Dose ◽

Systemic Lupus ◽

Serum Lipase ◽

Autoimmune Pathology ◽

Short Disease Duration

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. Methods A literature search was conducted using the terms “Pancreatitis” and “Lupus Erythematosus, Systemic” on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Results Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of “idiopathic” SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. Conclusion The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

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A Rare Case Report of Pseudo Pancreatic Cyst in a Child

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/520 ◽

2021 ◽

Vol 10 (31) ◽

pp. 2535-2537

Author(s):

Syed Athhar Saqqaf ◽

Amar Taksande ◽

Revat Meshram

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Report ◽

World Literature ◽

Pancreatic Pseudocyst ◽

Fibrous Tissue ◽

Previous History ◽

Pancreatic Cysts ◽

Serum Lipase ◽

History Of

It is difficult to diagnose pancreatic cysts in children. Any previous history of acute pancreatitis is very important because it can lead to a wide set of complications like pseudocyst, pancreatic necrosis, splenic venous thrombosis etc. The most known and common cause of pancreatic pseudocyst in children is trauma. The characteristic features of pancreatitis include abdominal pain, serum lipase or amylase values three times more than that of the normal range and characteristic radiological features. Pancreatic pseudocyst may occur in 15 % of children with acute pancreatitis as a complication.1 Pancreatic juice collection enclosed by a wall of granulation or fibrous tissue, is defined as a pseudocyst. As the resulting cyst has no true endothelial lining, it is classified as a pseudocyst.2 The pseudocyst contains inflammatory pancreatic fluid, mainly the lipase enzyme or semisolid matter. The incidence of pseudocyst is relatively low 1.6 % - 4.5 %, or 0.5 - 1 per 100 000 adults per year.2 Very few cases of pancreatic pseudocyst have been reported in world literature. Commonly, it develops as a sequel of acute or chronic pancreatitis. It develops around 4 weeks after the episode of acute pancreatitis.3 It is characterized by pancreatic inflammation, abdominal pain and raised levels of serum digestive enzymes.4 Here we discuss a case report of pancreatic pseudocyst in a 10-year-old male child presenting with history of abdominal pain and decreased appetite.

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Strictures, stones and cysts: an unusual cause of pancreatitis in a 20-month-old female child

BMJ Case Reports ◽

10.1136/bcr-2020-234966 ◽

2020 ◽

Vol 13 (7) ◽

pp. e234966

Author(s):

Alina Zufall ◽

Jeremy P Middleton ◽

Sara Rasmussen ◽

Reza J Daugherty

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Clinical Symptoms ◽

Stone Formation ◽

Abdominal Mass ◽

Biliary Tree ◽

Female Child ◽

Choledochal Cysts ◽

Patient Morbidity ◽

Duct Stricture

Choledochal cysts are dilations of the biliary tree that cause a variety of clinical symptoms and can lead to several types of complications. Choledochal cysts are most commonly diagnosed in childhood and frequently present with abdominal pain, jaundice and, in infants, an abdominal mass. Although the most concerning complication is malignant transformation of the cyst epithelium, other complications such as stone formation, acute pancreatitis and stricture can also occur and lead to patient morbidity. Treatment is aimed at not only relieving patient symptoms, but also decreasing a long-term cancer risk. We present a case of a child presenting with abdominal pain and vomiting secondary to a type IVa choledochal cyst complicated by acute pancreatitis, a common bile duct stricture and cystolithiasis.

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The Role of Routine Assays of Serum Amylase and Lipase for the Diagnosis of Acute Abdominal Pain

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x392135 ◽

2009 ◽

Vol 91 (5) ◽

pp. 381-384 ◽

Cited By ~ 21

Author(s):

Paul A Sutton ◽

David J Humes ◽

Gemma Purcell ◽

Janette K Smith ◽

Frances Whiting ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Serum Amylase ◽

Reference Range ◽

Acute Abdominal Pain ◽

Clinical Suspicion ◽

University Teaching ◽

Data Set ◽

Serum Lipase

INTRODUCTION We aimed to evaluate the role of routine measurements of serum amylase and lipase in the diagnosis of acute abdominal pain. PATIENTS AND METHODS We identified all patients who had serum amylase and lipase assays over a 62-day period at a single university teaching hospital and reviewed their case notes. RESULTS We excluded 58 of the 1598 patients on grounds of ineligibility (< 18 years of age and those transferred from other hospitals). A complete data set was obtained for 1520 (98.7%) of the remaining 1540 patients. Only 9.1% of requests were based on a clinical suspicion of acute pancreatitis. Of the 44 (2.9%) patients who had acute pancreatitis, only 28 (63.6%) had an associated rise in serum amylase and/or lipase 3 times above the maximum reference range, the remainder being diagnosed radiologically. At this cut-off range, the sensitivity and specificity for serum amylase were 50% and 99%, and those for serum lipase 64% and 97%, respectively. CONCLUSIONS Routine measurements of serum amylase and lipase are unhelpful in the diagnosis of acute abdominal pain unless there is clinical suspicion of acute pancreatitis. In these patients, assay of lipase alone is preferable to assay of amylase alone or both enzymes.

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Acute Pancreatitis in a Patient With COVID-19 After the Resolution of Respiratory Symptoms

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211024773 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110247

Author(s):

Hafiz Muhammad Abrar Jeelani ◽

Muhammad Mubbashir Sheikh ◽

Shirly Susan Samuel ◽

Yetunde Bernice Omotosho ◽

Artem Sharko ◽

...

Keyword(s):

Acute Pancreatitis ◽

Angiotensin Converting Enzyme ◽

Respiratory Symptoms ◽

Epigastric Pain ◽

The Novel ◽

Converting Enzyme ◽

Angiotensin Converting Enzyme 2 ◽

Novel Coronavirus

The gastrointestinal (GI) involvement, including acute pancreatitis (AP) from the novel coronavirus disease-2019 (COVID-19), is increasingly being reported. Recent evidence suggests that the pathogenesis of COVID-19 is mediated by the angiotensin-converting enzyme 2 (ACE-2) receptors and transmembrane protease serine 2 (TMPRSS2) for “priming,” which is highly expressed in the pancreas. To our knowledge, there is no other reported case of AP associated with COVID-19 after the respiratory symptoms are resolved. In this article, we present a patient with COVID-19, who came with intractable epigastric pain and resolved respiratory symptoms. A diagnosis of AP complicated with COVID-19 was made after laboratory and imaging workup, which was successfully managed conservatively.

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A comparative analysis of urine trypsinogen-2 test strip with serum lipase in diagnosis of acute pancreatitis in emergency set-up

International Surgery Journal ◽

10.18203/2349-2902.isj20185482 ◽

2018 ◽

Vol 6 (1) ◽

pp. 252

Author(s):

Jagmohan Mishra ◽

Biplab Mishra ◽

Afroza Firodous

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Acute Abdominal Pain ◽

High Specificity ◽

Test Strip ◽

Confirmatory Test ◽

Serum Lipase ◽

Reference Limit ◽

Set Up ◽

Upper Reference Limit

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence to segregate this disease is important from other specific or non-specific causes of acute abdomen. Hence in suspected cases in majority of patients the urinary trypsinogen-2 test strip (Actim pancreatitis) can be used to detect this disease, especially in emergency set-up. The result of the strip test is then corroborated with findings of serum lipase in the blood.Methods: Author prospectively compared 205 consecutive patients with acute abdominal pain admitted to the casualty, SCB Medical College and Hospital. The patients were tested on admission with the Actim pancreatitis test strip. Serum amylase, serum lipase, and urine trypsinogen-2 concentrations were also determined quantitatively.Results: The Actim pancreatitis test strip was sensitive in 93% cases and specific in 92% cases. This was superior to that of serum lipase (sensitivity 77% and specificity 87%). With a cut-off >3x the upper reference limit, the sensitivity of serum lipase was only 52% while the specificity was 98%. The high sensitivity for the Actim pancreatitis test strip resulted in every high negative predictive value of 99%.Conclusions: In patients with acute abdominal pain seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis. With its high specificity with a cut-off >3x the upper reference limit, serum lipase is suitable as a confirmatory test for pancreatitis when a positive dipstick result is obtained.

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A novel treatment protocol in severe acute pancreatitis: the first double blinded comparative trial to assess efficiency of omega 3 fatty acid infusion

International Surgery Journal ◽

10.18203/2349-2902.isj20214742 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3541

Author(s):

Rudraiah H. G. M. ◽

Benita Davis

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Clinical Symptoms ◽

Treatment Protocol ◽

Medical Expenditure ◽

Therapeutic Window ◽

Randomised Control Trial ◽

Omega 3 ◽

Serum Lipase ◽

Pufa Supplementation

Background: For decades, the treatment of acute pancreatitis (AP) has been largely supportive. However, a therapeutic window for intervention using immune modulators exists between the onset of clinical symptoms and peak pro-inflammatory cytokine expression. Soybean oil derived ω-3 PUFA is shown to inhibit the formation of ω-6 PUFA derived pro-inflammatory eicosanoids and suppresses pro-inflammatory activity of nuclear transcription factors (NF-κβ); thus, bringing about a much-needed immune regulation, both locally and systemically. Our aim was to study the efficacy of ω-3 PUFA infusion in severe AP (SAP) and set a new treatment protocol.Methods: This, first of its kind, doubled blinded randomised control trial was undertaken to assess the efficacy of early ω-3 PUFA supplementation in patients with predicted SAP by using serum amylase, serum lipase and C-reactive protein (CRP) with BISAP and Marshal scoring systems as markers for clinical outcome. 60 such patients were randomised into two groups: 30 were given ω-3 PUFA infusion and 30 were given a placebo. Chi square test and unpaired t test were used for comparison.Results: ω-3 PUFA infusion was found to be highly significant (p<0.05) in bringing about clinical improvement, reduced progression of SAP, reduced hospital stay and prompt reversal of organ dysfunction and SIRS.Conclusions: ω-3 PUFA infusion is the future for the treatment of patients with SAP. This drug is cheap and easily available, has no known side effects, reduces the morbidity and mortality, reduces the duration of hospital stay; thus, resulting in overall reduced medical expenditure.

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Pancreatic Injury after COVID-19 Vaccine—A Case Report

Vaccines ◽

10.3390/vaccines9060576 ◽

2021 ◽

Vol 9 (6) ◽

pp. 576

Author(s):

Artur Cieślewicz ◽

Magdalena Dudek ◽

Iwona Krela-Kaźmierczak ◽

Anna Jabłecka ◽

Maciej Lesiak ◽

...

Keyword(s):

Clinical Trials ◽

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Report ◽

Adverse Effects ◽

Medicinal Product ◽

Pancreatic Injury ◽

Genetically Engineered ◽

Close Monitoring ◽

Safety And Efficacy

The COVID-19 pandemic has caused more than 3 million deaths worldwide. Recently developed genetically engineered vaccines are the most critical solution for controlling the pandemic. Clinical trials on a large number of participants confirmed their safety and efficacy. However, with the growing number of vaccinated people, new infrequent adverse effects have been reported, not described in the medicinal product characteristics. We would like to report a case of acute pancreatic injury that occurred shortly after administering Pfizer BioNTech COVID-19 mRNA vaccine (Comirnaty). The report points out the potential need for close monitoring of patients reporting abdominal pain after vaccination (unresponsive to standard oral painkillers) because such symptom can be associated with acute pancreatitis.

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