Acute Pancreatitis In Type 2 Diabetes Mellitus With Multiple Stones In The Cystic Ductus

Hana Indriyah Dewi, Adhizti Naluriannisa Edya Nugraha, Rianita Marthasari, Basundara Aditya Hernawan, Desy Puspa Putri, Nurhasan Agung Prabowo

Abstract

Introduction: Severe upper abdominal pain is one of the symptoms of acute pancreatitis that often occurs in other diseases, such as peptic ulcer, acute hepatitis, cholangitis, and cholecystitis. Gallstone-induced acute pancreatitis has considerable morbidity and mortality.

Case illustration: A 50-year-old man came to the ED with a chief complaint of severe abdominal pain in the upper abdomen, VAS 8-9. His past medical history was unknown. On arrival, blood pressure was 141/102 mmHg, pulse was 98x/minute, and temperature was 36.4ºC. CT Scan of the abdomen showed pancreatitis and multiple stones in the cystic duct. Amylase and lipase serum results were 1897U/L and >3000 U/L.

Discussion: In acute pancreatitis caused by gallstones, stones usually get stuck in the branches of the pancreaticobiliary duct. Obstruction at this location causes reflux of bile into the pancreatic duct. Smaller gallstones are more likely to induce pancreatitis because they migrate more easily between bile ducts. This patient was suspected of having a previously unknown history of DM, which contributed to the patient's worsening condition.

Conclusion: Early management and treatment of triage, fluid resuscitation, and detection of local or systemic complications are essential. In pancreatitis due to gallstones, decisions about the need and timing of procedural intervention are critical. 

Keywords

Gallstones; Pancreatitis; Type 2 Diabetes Mellitus.

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References

1. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES guidelines for managing severe acute pancreatitis. World J Emerg Surg. 2019;14(1):1–20.

2. Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, Ascending Cholangitis, and Gallstone Pancreatitis. Med Clin North Am. 2008;92(4):925–60.

3. Kvit AD, Tutka MM, Kunovskiy V V. Acute Complicated Pancreatitis and Diabetes Mellitus: the Role and Significance of the Biochemical Indicators of Carbohydrate and Lipid Metabolism As a Prognostic Criterion for the Severity of the Disease Clinical Course. Wiad Lek. 2021;74(1):22–7.

4. Mikó A, Farkas N, Garami A, Szabó I, Vincze Á, Veres G, et al. Preexisting Diabetes Elevates Risk of Local and Systemic Complications in Acute Pancreatitis: Systematic Review and Meta-analysis. Pancreas. 2018;47(8):917–23.

5. Yoon SB, Lee IS, Choi MH, Lee K, Ham H, Oh HJ, et al. Impact of Fatty Liver on Acute Pancreatitis Severity. Gastroenterol Res Pract. 2017;2017.

6. Bazerbachi F, Haffar S, Hussain MT, Vargas EJ, Watt KD, Murad MH, et al. Systematic review of acute pancreatitis associated with interferon-α or pegylated interferon-α: Possible or definitive causation? Pancreatology [Internet]. 2018;18(7):691–9. Available from: http://dx.doi.org/10.1016/j.pan.2017.08.012

7. Dharmalingam M, Yamasandhi PG. Nonalcoholic fatty liver disease and Type 2 diabetes mellitus. Indian J Endocrinol Metab. 2018;22(3):421–8.

8. DiMagno MJ, Mandalia A, Wamsteker EJ. Recent advances in understanding and managing acute pancreatitis. F1000Research. 2019;7(0):1–12.

9. Bhatia M, Fei LW, Cao Y, Hon YL, Huang J, Puneet P, et al. Pathophysiology of acute pancreatitis. Pancreatology. 2005;5(2–3):132–44.

10. Venneman NG, Renooij W, Rehfeld JF, VanBerge-Henegouwen GP, Go PMNYH, Breeders IAMJ, et al. Small gallstones, preserved gallbladder motility, and fast crystallization are associated with pancreatitis. Hepatology. 2005;41(4):738–46.

11. Solanki NS, Barreto SG, Saccone GTP. Acute pancreatitis due to diabetes: The role of hyperglycaemia and insulin resistance. Pancreatology [Internet]. 2012;12(3):234–9. Available from: http://dx.doi.org/10.1016/j.pan.2012.01.003

12. Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, et al. The Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report from the NASPGHAN Pancreas Committee. Journal of pediatric gastroenterology and nutrition.2017;66:159–176 p.

13. Arvanitakis M, Dumonceau JM, Albert J, Badaoui A, Bali MA, Barthet M, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018;50(5):524–46.

14. Sellers ZM, Abu-El-Haija M, Husain SZ, Morinville V. New Management Guidelines for Both Children and Adults With Acute Pancreatitis. Gastroenterology [Internet]. 2018;155(1):234–5. Available from: https://doi.org/10.1053/j.gastro.2018.03.068

DOI: https://doi.org/10.20961/tscm.v1i1.55863

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