Pancreatic herniation: a rare cause of acute pancreatitis?

Abstract

Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms. However, there have been only isolated reports of these cases presenting as acute pancreatitis. While the majority of acute pancreatitis cases can be explained by common causes, it is important that clinicians be aware of and should consider investigating for other more unusual possibilities, such as pancreatic herniation, before labelling an episode as ‘idiopathic’.

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

“…Herniation of pancreas can be without symptoms and found accidentally on imaging or as a sequel to acute pancreatitis. Acute pancreatitis as a sequela of this mechanism is very rare and has been previously reported in 13 patients [13][14][15][16][17][18][19][20][21][22][23][24][25]. Table 1 lists acute pancreatitis caused by the herniation of pancreas in HH from previous reports.…”

“…Cases of pancreatic herniation with pancreatitis are rare; therefore, the ideal treatment is still unclear [20,21]. Some HH cases with pancreatitis were treated with surgery in the past [13,14,17,24], but in other cases, physicians chose conservative treatment including administration of intravenous fluids, pain killers, and diet as tolerated because of high risk of surgery [15,16] or patient's refusal to undergo operation [16,[18][19][20][21].…”

Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature

“…In the last 25 years, 17 cases of intrathoracic herniation of (parts of) the pancreas have been reported ( [4,10,11,[16][17][18][19], vomiting [17,18], dysphagia [4] or dyspnea [2,16,20]. Five cases, however, were diagnosed with pancreatitis secondary to intrathoracic pancreatic herniation [3,6,[13][14][15], one of which was associated with pancreatic torsion [6]. While pancreatitis is known to occur as a result of pancreatic herniation, large and giant hiatal hernia without pancreatic involvement may also present with acute or recurrent pancreatitis.…”

A Rare Case of Pancreatitis From Pancreatic Herniation

“…Table 1 [3,[7][8][9][10][11][12][13][14][15] lists the cases of acute pancreatitis from pancreatic herniation in hiatal hernias from published literature. All cases were diagnosed based on exclusion of other etiologies for acute pancreatitis.…”