Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis, what should be done?

Al‐Haddad, Mohammad; Wallace, Michael B.

doi:10.3748/wjg.14.1007

Cited by 67 publications

(67 citation statements)

References 32 publications

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“…Endoscopic ultrasonography is a safe first-line test to evaluate the condition of most patients with acute recurrent pancreatitis. 10 Although magnetic resonance cholan- giopancreatography has limited availability and high cost, it is rapidly becoming the noninvasive test of choice to diagnose the condition. However, endoscopic retrograde cholangiopancreatography remains the test of choice to diagnose or manage pancreas divisum for most patients.…”

Section: Investigationsmentioning

confidence: 99%

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Pancreas divisum: a cause of idiopathic acute pancreatitis

Tarabain²

2009

Canadian Medical Association Journal

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A previously healthy 23-year-old woman presented to hospital with 2 months of intermittent dyspepsia following meals and acute-onset epigastric pain, nausea and vomiting. Based on the results of laboratory investigations (lipase > 1900 [normal < 286] U/L), acute pancreatitis was diagnosed. It was treated conservatively with analgesics and intravenous hydration. The results of other laboratory tests, including those for amylase, leukocytes and creatinine, were within normal limits. No obvious reversible causes of pancreatitis were initially identified. The patient reported consuming alcohol rarely. Ultrasonography of the abdomen ruled out gallstones. A computed tomography (CT) scan of her abdomen and pelvis showed that her pancreas had a relatively normal appearance; however, assessment was limited because of minimal intra-abdominal fat in her upper abdomen in the region of the pancreatic head. After 2 days, the patient's pain had improved but her lipase level remained above 500 U/L. The patient's abdominal pain and lipase levels (829 U/L) increased after she resumed eating solid foods.Ultrasonography performed 21 days after admission showed gallbladder "sludge" with no evidence of stones.Laparoscopic cholecystectomy was performed. The results of tests for autoimmune pancreatitis (antinuclear antibodies and IgG subtypes) were negative. However, the patient had persistent abdominal pain and an elevated lipase level above 1000 U/L. Twenty-eight days after admission, she underwent magnetic resonance cholangiopancreatography, which showed pancreas divisum. Following endoscopic retrograde cholangiopancreatography (Figure 1), a sphincterotomy on the major papilla was performed with no noteworthy clinical improvement. Six weeks later, endoscopic retrograde cholangiopancreatography was repeated, with sphincterotomy of the minor papilla and placement of a stent. The patient's pain resolved, and her lipase levels returned to normal within 14 days. Discussion Anatomy and epidemiologyIn over 90% of healthy people, the dorsal and ventral endodermal pancreatic buds fuse to form the adult pancreas. However, in about 10% of the population, fusion does not occur, resulting in pancreas divisum (Figure 2), which is the most common congenital ductal anomaly of the pancreas. 1 The classic anatomy of pancreas divisum consists of a small ventral duct, which drains through the larger major papilla, and the larger dorsal duct, which drains through the smaller minor papilla. 2,3In patients with a large dorsal duct, the majority of the pancreatic secretions (up to 2000 mL daily) pass through this duct.2 Pancreas divisum through the minor papilla (instead of the major papilla) can result in inadequate drainage and pain Key points• Pancreas divisum is a congenital anomaly that occurs in about 10% of the population and is a potentially treatable cause of acute pancreatitis.• The lifetime risk of pancreatitis for patients with pancreas divisum (5%-10%) is similar to risk in the general population.• Pancreas divisum should be considered in pa...

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Section: Investigationsmentioning

confidence: 99%

“…However, endoscopic retrograde cholangiopancreatography remains the test of choice to diagnose or manage pancreas divisum for most patients. 10 The sensitivity and specificity of the different imaging modalities for diagnosing pancreas divisum have yet to be compared.…”

Section: Investigationsmentioning

confidence: 99%

Pancreas divisum: a cause of idiopathic acute pancreatitis

Tarabain²

2009

Canadian Medical Association Journal

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“…In the absence of these etiologies, metabolic disorders such as hypertriglyceridemia or hypercalcemia must be excluded. Less frequent causes include anatomical or physiological abnormalities of the pancreas, such as pancreas divisum or sphincter of Oddi dysfunction (1,2), which are present in up to 15% of the population (1). It is important to detect the origin of the pancreatitis to prevent further recurrent episodes.…”

Section: Introductionmentioning

confidence: 99%

“…It is important to detect the origin of the pancreatitis to prevent further recurrent episodes. Although diagnosis is straightforward in most patients, up to 10% of acute pancreatitis and 30% of recurrent pancreatitis do not have a clear origin and are catalogued as idiopathic pancreatitis (2). They are defined as pancreatitis with an unknown cause after the laboratory (including calcium and lipid profile) and imaging tests (abdominal ultrasound, abdominal CT and cholangiography) (1,2).…”

Section: Introductionmentioning

confidence: 99%

Case of drug-induced acute pancreatitis produced by horsetail infusions

et al. 2017

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Introduction:The most frequent causes of acute pancreatitis are biliary stones, alcohol consumption, smoking and tumors. Some of them do not have any established cause, and they are catalogued as idiopathic pancreatitis.Case report: We report the case of a 56-year-old woman with a history of bilateral adrenalectomy on hormone replacement therapy with corticosteroids, who has recurrent episodes of mild acute pancreatitis with an etiologic study (laboratory and imaging tests) without significant findings. A drug-induced etiology was suspected, so corticosteroids were removed and antihypertensive treatment was modified, but the clinical manifestations persisted. Later regular consumption of horsetail infusions was detected, and after their suspension the patient became asymptomatic and has not presented new episodes.Discussion: The drug-induced acute pancreatitis is a strange cause of pancreatitis that is frequently underdiagnosed because of the difficulty to establish a relationship between the drugs and the pancreatitis. Lots of drugs have been related with acute pancreatitis, while the information available for herbal products is limited. They usually present like mild and recurrent episodes, without significant findings in both laboratory and imaging tests (abdominal ultrasound, abdominal computed tomography [CT], cholangiography and endoscopic ultrasound). It is important to detect the origin of this type of pancreatitis to prevent recurrence.

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“…Idiopathic AP is defined as pancreatitis with no etiology established after initial laboratory and imaging tests (transabdominal ultrasound and CT in the appropriate patient) [63]. Patients with idiopathic AP should be evaluated at specialized centers on pancreatic diseases, applying combined multidisciplinary approach, including advanced endoscopy [1].…”

Section: Endoscopic Therapy In Idiopathic Acute Pancreatitismentioning

confidence: 99%

Endoscopic Treatment of Pancreatic Diseases

Vladimirov¹,

Getzov²,

Ivanova³

2015

Endoscopy - Innovative Uses and Emerging Technologies

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Endoscopic therapy has been increasingly recognized as an effective method of treatment in selected patients with pancreatic diseases. Various endoscopic procedures, classical and modified, are used for the complex treatment of acute and chronic pancreatitis, as well as their complications. In pancreatic carcinoma, some endoscopic methods are applied mainly as palliative measures. There are still open questions regarding the placing and timing of various endoscopic procedures in the multidisciplinary management approach of pancreatic diseases.

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Diagnostic approach to patients with acute idiopathic and recurrent pancreatitis, what should be done?

Cited by 67 publications

References 32 publications

Pancreas divisum: a cause of idiopathic acute pancreatitis

Pancreas divisum: a cause of idiopathic acute pancreatitis

Case of drug-induced acute pancreatitis produced by horsetail infusions

Endoscopic Treatment of Pancreatic Diseases

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