Acute Pancreatitis After Percutaneous Mechanical Thrombectomy of a Thrombosed Arteriovenous Fistula

Background: In the United States, approximately 275,000 cases of acute pancreatitis are diagnosed annually, making acute pancreatitis the leading gastrointestinal cause of hospitalization.The most common etiologies are gallstones and alcohol use, but many cases have inconspicuous etiologies.Case Report: A 69-year-old female with a history of end-stage renal disease on hemodialysis presented with acute epigastric abdominal pain hours after undergoing an uncomplicated percutaneous mechanical thrombectomy of a stenosed arteriovenous fistula.Laboratory and imaging findings were consistent with acute pancreatitis without evidence of gallstones.Her pancreatitis was attributed to inflammation caused by hemolysis that occurred during the procedure she underwent earlier that same day.Conclusion: During thrombectomy, intravascular hemolysis releases free hemoglobin and heme products.These substances can generate an inflammatory response through the production of acute phase reactants and free oxygen radicals.The microvasculature of the pancreas is susceptible to this inflammatory cascade, and in some patients, the result is acute pancreatitis.The mechanism through which the pancreas is susceptible to inflammation associated with hemolysis is poorly understood.