Acute pancreatitis during sickle cell vaso‐occlusive painful crisis

Abstract

Sickle cell disease is characterized by chronic hemolytic anemia and vaso-occlusive painful crisis. The vascular occlusion in sickle cell disease is a complex process and accounts for the majority of the clinical manifestations of the disease. Abdominal pain is an important component of vaso-occlusive painful crisis and may mimic diseases such as acute appendicitis and cholecystitis. Acute pancreatitis is rarely included as a cause of abdominal pain in patients with sickle cell disease. When it occurs it may result form biliary obstruction, but in other instances it might be a consequence of microvessel occlusion causing ischemia. In this series we describe four cases of acute pancreatitis in patients with sickle cell disease apparently due to microvascular occlusion and ischemic injury to the pancreas. All patients responded to conservative management. Acute pancreatitis should be considered in the differential diagnosis of abdominal pain in patients with sickle cell disease. Am. J. Hematol. 73:190-193, 2003.

Pancreatitis in the Setting of Vaso-occlusive Sickle Cell Crisis: A Rare Encounter

“…Exchange transfusion may be the therapy of choice in patients with acute multi-organ failure. It works by diluting hemoglobin S and consequently reducing intravascular sickling, as demonstrated in our case [5]. There is no consensus on hemoglobin S goal but most authors recommend less than 20% to 30% in individuals with homozygous sickle mutation [3].…”

“…The most frequent causes are acute cholecystitis, opioid-induced constipation, renal papillary necrosis, hepatic sequestration, splenic sequestration, urinary tract infection, peptic ulcer disease, and ischemic bowel [5]. Acute ischemic pancreatitis is a very rare complication of VOC.…”

“…In addition to abdominal pain, our patient had elevated serum lipase and computed tomographic (CT) findings of acute pancreatitis. There was no evidence of drug, alcohol, trauma, toxin, or an obstructive etiology thereby suggesting that pancreatitis was likely due to ischemic etiology from sickling [5]. …”

Hepatobiliary Manifestations of Sickle Cell Anemia

“…Commonly, it is seen in patients with cholelithiasis as a result of common bile duct obstruction but there are reports of pancreatitis in patients with SCA without cholelithiasis. In these patients, pancreatitis may be due to microvascular occlusion and ischemic injury to the pancreas [38]. Acute pancreatitis should be considered in the differential diagnosis of abdominal pain in patients with SCA.…”

Unusual causes of abdominal pain: sickle cell anemia

“…[74][75][76] Despite a high incidence of gallstones in patients with SCD, acute pancreatitis is rarely included as a cause of abdominal pain in these patients. Patients with SCD are at risk of acute pancreatitis both from biliary obstruction and from ischemic injury to the pancreas and activation of pancreatic enzymes as a consequence of micro-vessel occlusion.…”