Clinical Case Report: a Patient with acute biliary Pancreatitis

A 75-year-old man was admitted to the hospital with severe pain in the epigastric region of the abdomen, he had nausea and one episode of self-vomiting, the patient related his complaints to taking persimmons. Mayo-Robson sign is negative. The patient has undergone coronary artery bypass grafting and coronary artery stenting twice, including the last 2 months ago. Cardiological consultation, abdominal roentgenoscopy and ultrasound were performed in the hospital. As a result of the examinations carried out in the clinic, concomitant diseases were revealed: diverticular disease of the urinary bladder, diverticular disease of the large intestine without perforation and abscesses, aneurysm of the femoral artery, atherosclerotic heart disease, increased blood glucose level and lipoprotein metabolism disorders were revealed. The patient complains of primary hypertension. Despite the conducted examinations, the diagnosis was complicated by very few clinical complaints. The correct diagnosis was determined by a sharp increase in the concentration of lipase in the blood analysis. Lipase is an enzyme that hydrolyzes triglycerides. It is produced by the pancreas and secreted through the pancreatic duct into the duodenum, where it participates in the digestion of dietary fats. Lipase analysis is mainly prescribed for diagnosis and monitoring of acute pancreatitis. A lipase assay was performed in the hospital and the reading was 2900 U/L (N 23-300 U/L). Since there were no clinical signs on the face except for abdominal pain, it was necessary to check the lipase level and on repeat analysis it was found to be 2605 U/L (N 23-300 U/L). On ultrasound, the gallbladder was enlarged and full, with a small effusion. Despite the few clinical signs, the analyzes confirmed the diagnosis of acute biliary pancreatitis and acute cholecystitis. The patient was placed in a surgical ward and started with infusion, spasmolytic, Gastroprotective, anticoagulant, anti-inflammatory and other symptomatic therapy. The patient was discharged to the apartment in 5 days with satisfactory indicators. It was believed that the patient's biliary tract was blocked by a biliary concretion, which caused obstruction of the lumen and bile congestion, which in turn manifested as biliary pancreatitis. Since gallstones were not detected on X-ray studies, it was possible that after the use of antispasmodics, they passed into the lumen of the intestine and the patency of the duct was restored. As a result of the treatment, the patient fully recovered.