Gülali AKTAŞ, Arif DURAN, Aytekin ALÇELİK, Sevim KARAÇAY, Haluk ŞAVLI, Safiye GÜREL, Arzu CANAN

Silent ischemic pancreatitis following urosepsis

Pancreatic ischemia is an uncommon cause of acute pancreatitis. Ischemia with resultant pancreatitis has been reported in vasculitis, atheroembolism, intraoperative hypotension, survivors of cardiac arrest and hemorrhagic shock. Ischemic acute pancreatitis is difficult to recognize clinically. In this report we present a 63 year old woman with painless ischemic pancreatitis following urosepsis. We suggest that if a critically ill patient is hypotensive for more than 24-48 hours, amylase levels must be monitored to establish ischemic acute pancreatitis (AP) even if the patient remains asymptomatic.

Keywords:

Asymptomatics, Hypotension, Ischemic pancreatitis, Urosepsis,

PDF

___

Balthazar, E.J., 2002. Acute pancreatitis: Assessment of severity with clinical and CT evaluation. Radiology. 223, 603-613.
Buchler, M.W., Gloor, B., Müller, C.A, Friess, H., Seiler, C.A., Uhl, W., 2000. Acute necrotizing pancreatitis: Treatment strategy according to the status of infection. Ann. Surg. 232, 619-626.
Drissi, M., Madani, M., Hatim, A., Ibat, D., Athmani, M., Taberkant, M., Houssa, M.A., Alaoui, M., Boulahya, A., 2009. Severe acute pancrea- titis after surgical treatment of a ruptured abdominal aortic aneurysm. Ann. Vasc. Surg. 23, 785-787.
Fernandez-del Castillo., C., Harringer, W., Warshaw, A.L., Vlahakes, G.J., Koski, G., Zaslavsky, A.M., Rattner, D.W., 1991. Risk factors for pancreatic cellular injury after cardiopulmonary by pass. New Engl. J. Med. 325, 382-387.
Gullo, L., Cavicchi, L., Tomassetti, P., Spagnolo, C., Freyrie, A., D’Addato, M. , 1996. Effects of ischemia on the human pancreas. Gastroenter- ology. 111, 1033-1038.
Hackert, T., Hartwig, W., Fritz, S., Schneider, L., Strobel, O., Werner, J., 2009. Ischemic acute pancreatitis: Clinical features of 11 patients and review of the literature. Am. J. Surg. 197, 450-454.
Hoffmann, T. F., Leiderer, R., Waldner, H., Arbogast, S., Messmer, K., 1995. Ischemia reperfusion of the pancreas: A new in vivo model for acute pancreatitis in rats. Res. Exp. Med. 195, 125-144.
Klar, E., Endrich, B., Messmer, K., 1990. Microcirculation of the pancreas. A quantitative study of physiology and changes in pancreatitis. Int. J. Microcirc. Clin. Exp. 9, 85-101.
Kobayashi, Y., Kanemitu, T., Kamoto, A., Satoh, M., Mori, N., Sekii, K., Yoshioka, T., Itatani, H., Fujimoto, T., 2011. Painless acute pancreatitis associated with sorafenib treatment: A case report. Med. Oncol. 28, 463-465.
Ocal, S., Selcuk, H., Korkmaz, M., Unal, H., Yilmaz, U., 2010. Acute pancreatitis following doxycycline and ornidazole coadministration. JOP. 11, 614-616.
Orvar, K., Johlin, F.C., 1994. Atheromatous embolization resulting in acute pancreatitis after cardiac catheterization and angiographic studies. Arch. Intern. Med. 154, 1755-1761.
Piton, G., Barbot, O., Manzon, C., Moronval, F., Patry, C., Navellou, J.C., Belle, E., Capellier, G., 2010. Acute ischemic pancreatitis following cardiac arrest: A case report. JOP. 11, 456-459.
Piton, G., Navellou, J.C., Morati, P., Patry, C., Carbonnel, F., Capellier, G., 2008. Thrombotic thrombocytopenic purpura associated with severe acute pancreatitis in a context of decreased ADAMTS13 activity: A case report. Eur. J. Gastroen. Hepat. 20, 1226-1230.
Sakorafas, G.H., Tsiotos, G.G., Sarr, M.G., 2000. Ischemia/Reperfusion-Induced pancreatitis. Digest. Surg., 17, 3-14.
Swanson, K.E., Ward, E. M., Wolfsen, H.C., 2003. Painless pancreatitis after implantation of a biventricular assistive device. Transpl. P. 35, 1546-1548.
Uhl, W., Warshaw, A., Imrie, C., Bassi, C., McKay, C.J., Lankisch, P.G., Carter, R., Di Magno, E., Banks, P.A., Whitcomb, D.C., Dervenis, C., Ulrich, C.D., Satake, K., Ghaneh, P., Hartwig, W., Werner, J., McEntee, G., Neoptolemos, J.P., Büchler, M.W. International Association of Pancreatology., 2002. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2, 565-573.
Villatoro, E., Bassi, C., Larvin, M., 2006. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Co- chrane Db. Syst. Rev. 4, 294.
Warshaw, A.L., O’Hara, P.J., 1978. Susceptibility of the pancreas to ischemic injury in shock. Ann. Surg. 188, 197-201.
Werner, J., Hartwig, W., Hackert, T., Büchler, M.W., 2005. Surgery in the treatment of acute pancreatitis-open pancreatic necrosectomy. Scand. J. Surg. 94, 130-134.