Maria Bajwa, MD1, Saif Bella, MD2, Leslie Bank, MD, FACG2
1United Health Services, Endicott, NY; 2United Health Services, Johnson City, NY
Introduction: Pancreatic ischemia is a rare cause for acute pancreatitis which is poorly defined without specific radiological appearance.
Case Description/Methods: We present a case of 57-year-female with 2-week history of abdominal pain. Her history included CHF, carotid stenosis, hypertension, COPD, and invasive Aspergillosis. She underwent cardiac catheterization 6 years ago which showed heavy atherosclerosis without obstruction. Her post procedure course was complicated by cholesterol embolization to left lower extremity. she was a heavy smoker with 1-2 PPD smoking but denied alcohol use. She was diagnosed with invasive Aspergillosis 2 months ago and initially treated with Voriconazole. It was switched to isavuconazole 1 month ago after developing blurring of vision. Patient reported decreased appetite since then with poor oral intake. She presented with 2 week h/o severe abdominal pain, associated with intense nausea and multiple episodes of vomiting.Her initial work up showed leukocytosis and elevated lipase >4000. CT abdomen showed diffuse, homogenous pancreatic enlargement with prominent aortic atherosclerosis and distal aortic aneurysm measuring 3.1 cm. Initially, the antifungal agent, isavuconazole was thought to be the culprit, causing pancreatitis but literature review was negative. IGg4 levels and lipid profile were unrevealing. Pancreatic ischemia was considered as the likely etiology. An abdominal duplex showed superior mesenteric artery stenosis. However, given h/o cholesterol embolization following cardiac catheterization, she was considered high risk for endo-vascular procedure. High intensity statin therapy was prescribed and she was discharged home with close outpatient follow up. Patient was strongly encouraged to quit smoking, as this would likely decrease her risk of major adverse cardiac event.
Discussion: Three well-identified causes of acute ischemic pancreatitis include hemorrhage, hypotension, & mesenteric vessel occlusion. Pancreatic ischemia leads to appearance of oxygen-derived free radicals which cause endothelial dysfunction, resulting in increased permeability and localized inflammatory response. Our patient had heavy calcified atherosclerosis. She was an active smoker. Dehydration also played a role in the development of ischemic pancreatitis, as the patient endorsed poor oral intake, confounded by nausea, vomiting and diarrhea. Treatment of acute ischemic pancreatitis consists of supportive care with IV fluids and pain control and restoration of pancreatic perfusion.
Citation: Maria Bajwa, MD; Saif Bella, MD; Leslie Bank, MD, FACG. P1911 - ACUTE ISCHEMIC PANCREATITIS SECONDARY TO SUPERIOR MESENTERIC ARTERY STENOSIS: A COMMON DIAGNOSIS DUE TO AN UNCOMMON ETIOLOGY. Program No. P1911. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.