Abstract Introduction Acute pancreatitis is among the most common etiologies of admission for abdominal pain. With mortality rates near 2%, most cases are mild; however, systemic complications may result in significant increases in mortality rates. While most complications are related to local changes including pancreatic necrosis and pseudocyst formation, major systemic complications may include abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and circulatory shock. The development of such systemic complications and especially persistent organ failure are poor prognostic indicators affording high mortality rates. Case Presentation Here we present a 44-year-old male with history of alcohol use disorder who presented with abdominal pain and vomiting. Initial workup revealed a triglyceride level of 3615 mg/dL, elevated lipase, and peri-pancreatic fat stranding on imaging. He was admitted for acute pancreatitis with multifactorial etiology in the setting of alcohol use and hypertriglyceridemia. He was started on intravenous fluids with transfer to the Intensive Care Unit for insulin infusion. Though initially hemodynamically stable, concern developed for abdominal compartment syndrome and increasing intravesical pressures to 35 mmHg despite non-operative decompression attempts. His clinical condition deteriorated including worsening hypoxemia and findings suggesting ARDS at which time the patient suffered cardiac arrest with return of spontaneous circulation achieved. Emergent bedside exploratory laparotomy was conducted by general surgery revealing hemorrhagic pancreatitis. The clinical course was complicated by development of DIC and shock with multi-organ failure requiring vasopressors and renal replacement therapy. The decision to not escalate care further was made with his family, and he expired on the fifth day of hospitalization. Discussion This case demonstrates a rare presentation of nearly all major complications of pancreatitis including local complication of pancreatic hemorrhage and major systemic complications of DIC, septic shock, ARDS, and abdominal compartment syndrome. Development of ARDS, while rare, has theorized mechanisms involving endothelial and epithelial injury with overwhelming inflammatory response. Additionally, the diagnosis of abdominal compartment syndrome carries significant morbidity and mortality without rapid intervention and is associated with multiple pathophysiologic factors including decreased abdominal wall compliance, increased intra-abdominal fluid, increased capillary permeability, and fluid resuscitation in the management of acute pancreatitis. Ultimately, the inflammatory response in acute pancreatitis should not be overlooked, especially in those with risk factors for severe disease. Recognition of life-threatening complications of this common condition requires high degrees of clinical suspicion and close monitoring of clinical course. This abstract is funded by: None
Palumbo et al. (Fri,) studied this question.