Idiopathic acute pancreatitis: a review on etiology and diagnostic work-up

Abstract

Acute pancreatitis (AP) is a common disease associated with a substantial medical and financial burden, and with an incidence across Europe ranging from 4.6 to 100 per 100,000 population. Although most cases of AP are caused by gallstones or alcohol abuse, several other causes may be responsible for acute inflammation of the pancreatic gland. Correctly diagnosing AP etiology is a crucial step in the diagnostic and therapeutic work-up of patients to prescribe the most appropriate therapy and to prevent recurrent attacks leading to the development of chronic pancreatitis. Despite the improvement of diagnostic technologies, and the availability of endoscopic ultrasound and sophisticated radiological imaging techniques, the etiology of AP remains unclear in ~ 10-30% of patients and is defined as idiopathic AP (IAP). The present review aims to describe all the conditions underlying an initially diagnosed IAP and the investigations to consider during diagnostic work-up in patients with non-alcoholic non-biliary pancreatitis.

Pathogenic Role of an IL-23/γδT17/Neutrophil Axis in Coxsackievirus B3–Induced Pancreatitis

“…Chronic pancreatitis is well known to predispose to pancreatic cancer development, the fourth cause of cancer-related deaths worldwide (4). Although alcohol abuse and gallstones are the main causes of AP, idiopathic pancreatitis such as viral pancreatitis represents a fairly high percentage of total cases (5). Type B Coxsackievirus (CVB) infection as a causing factor for AP was first reported in 1958 (6).…”

Surgical management of traumatic pancreatic injuries and their consequences.

“…5 Pancreatic trauma might trigger several consequences including pancreatic leaks, abscesses, pseudocysts, pancreatitis and pancreatic necrosis. [6][7][8][9][10] The risk of complications and mortality should be considered with extensive parenchymal and ductal injuries as well as when the diagnosis is delayed. 11,12 Evaluation of the extent of pancreatic injury by various imaging techniques in the setting of abdominal trauma might be demanding.…”

Diagnosis of idiopathic acute pancreatitis: the simpler, the better?

“…Acute pancreatitis continues to be one of the most common gastrointestinal (GI) conditions requiring hospitalization. The term "idiopathic acute pancreatitis" (IAP) is used when the most common causes of acute pancreatitis, like alcohol and gallstones, have been ruled out, with there also being no discernible etiology after extensive evaluation of patient history, physical examination, laboratory tests, and conventional imaging studies [1,2]. Transabdominal ultrasound and computed tomography (CT) are the usual initial imaging modalities and are indicated after causes such as drugs, infections, genetic mutations, and metabolic disorders, such as hypercalcemia and hypertriglyceridemia, have been ruled out.…”

“…Despite the above work-up, an etiology is not established in approximately 10 % -30 % of acute pancreatitis cases [4]. In such cases, current recommendations suggest at least two GI imaging techniques be performed that include endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) to further evaluate a cause for the acute pancreatitis [1,2]. Undetected microlithiasis and/or biliary sludge has been considered as one of the major undiagnosed causes of IAP accounting for 30 % -80 % of cases.…”

“…Undetected microlithiasis and/or biliary sludge has been considered as one of the major undiagnosed causes of IAP accounting for 30 % -80 % of cases. Other causes that could potentially be diagnosed by GI imaging modalities are pancreas divisum, sphincter of Oddi dysfunction, a choledochocele, an anomalous pancreaticobiliary junction, an annular pancreas, and pancreatic and/or ampullary neoplasms [1,2].…”