P0140 - Uncommon Complications of Acute Pancreatitis

Award: Presidential Poster Award

Michael Ramirez-Arenalde, MD¹, Asher Gorantla, MD¹, Anandita Kishore, MD², Harshavardhan Taluru, MD¹, Nisha Horton, MD¹, Selin Unal, MD¹, Mithil Gowda Suresh, MD³, Shruthi Sivakumar, MD¹, Rajesh Veluvolu, MD^4
1SUNY Downstate Health Sciences University, Brooklyn, NY; ²Sisters of Charity Hospital, University of Buffalo, Buffalo, NY; ³Saint Vincent Hospital, Worcester, MA; ⁴Kings County Hospital, NYC Health and Hospitals, Brooklyn, NY

Introduction: Complications of acute pancreatitis such as paralytic ileus, ischemic necrosis, perforation and mechanical obstruction are relatively infrequent. Paralytic ileus presents as nausea, vomiting, abdominal pain and distention. Imaging shows diffuse dilatation of bowel loops and no transition point. Combined with fluid resuscitation without frequent reassessment of intra-abdominal pressures (IAP), this can lead to visceral edema and pancreatic ascites. This can result in abdominal compartment syndrome (ACS) which can lead to multiple organ dysfunction syndrome (MODS) which is associated with increased mortality. We describe one case of severe paralytic ileus leading to intra-abdominal hypertension (IAH) in a young man with acute pancreatitis.

Case Description/Methods: A young man with alcohol use disorder presented with epigastric pain and palpitations. He was tachycardic to 122 bpm and had a blood pressure of 175/110 mmHg and was in acute distress, diaphoretic, altered with severe ataxia. His serum lipase was 2758 U/L, lactate 15.81 mmol/L. EKG showed sinus tachycardia. He was admitted to the medical ICU for acute pancreatitis and alcohol withdrawal. He was resuscitated with Ringer’s lactate at 175 cc/hr, and given thiamine, chlordiazepoxide and strict electrolyte replacement. He was found to have reduced urine output with diffusely tense abdomen and no bowel sounds on auscultation. Through the trans-bladder technique via Foley catheter, IAP was found to be 18 mmHg, consistent with Grade II IAH. Due to concern for small bowel obstruction, computed tomography of abdomen and pelvis with oral/intra-venous contrast was done showing dilated loops of small bowel and a long segment of colonic wall thickening at the splenic flexure with no discrete transition point (Fig 1). Fluid rate was reduced and nasogastric tube (NGT) was placed with 4L output. NGT on low intermittent suction was continued. His clinical status improved with normalization of IAP. After being started on clear liquid diet, he was referred to an inpatient substance abuse rehab on discharge.

Discussion: Fluid resuscitation is the main stay of treatment for acute pancreatitis but is seldom done with monitoring of IAP. Fluid resuscitation combined with paralytic ileus can acutely raise the IAP causing IAH/ACS leading to fatal hypoperfusion and ischemia of abdominal viscera. Hence, serial measurements of IAP should be considered early on in the treatment of pancreatitis when any known risk factor for ACS is present.



Disclosures:


Michael Ramirez-Arenalde, MD¹, Asher Gorantla, MD¹, Anandita Kishore, MD², Harshavardhan Taluru, MD¹, Nisha Horton, MD¹, Selin Unal, MD¹, Mithil Gowda Suresh, MD³, Shruthi Sivakumar, MD¹, Rajesh Veluvolu, MD⁴. P0140 - Uncommon Complications of Acute Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.