Necrotizing Pancreatitis Complicated by ARDS and GI Bleeding: A Case Report

Document Type

Conference Proceeding

Publication Date

10-1-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Acute necrotizing pancreatitis, though relatively rare comprising 10% of acute pancreatitis cases, carries high mortality and morbidity rates. This condition occurs when more than 30% of the pancreas is affected by necrosis. Additionally, acute respiratory distress syndrome (ARDS) in pancreatitis can lead to respiratory failure and increased mortality risk. Although gastrointestinal bleeding (GIB) is uncommon, it can be fatal. Case Description/Methods: A 54-year-old patient with presented with severe abdominal pain, fatigue, nausea, vomiting, loss of appetite, and weight loss. An abdominal CT scan confirmed necrotizing pancreatitis, and conservative therapy with Carbapenem was initiated. However, on the fifth day, the patient experienced bloody diarrhea and deteriorated rapidly. Hemoglobin dropped, chest X-ray revealed ARDS, and the patient was transferred to the ICU. Despite intubation attempts, the patient developed bradycardia, irregular beats, and ultimately went into cardiac arrest. Discussion: Acute pancreatitis is an inflammatory disease of the pancreas that triggers the release of pro-inflammatory mediators, causing systemic inflammation, endothelial dysfunction, and organ failure. Causes include gallstones, alcohol, trauma, infection, malignancy, and autoimmune factors. Complications include necrotizing pancreatitis, abscess formation, pseudocysts, hemorrhage, and ARDS. Bleeding can result from ulcers, erosions or direct vascular involvement. Hemorrhagic transformation, though rare, has high mortality and can be managed with angiography and embolization. Severity, necrosis, and mortality can be predicted using scoring systems, radiological scores, and biochemical markers. Acute necrotizing pancreatitis accounts for 5%-10% of cases and has varying prognosis based on sterile/infected necrosis. ARDS occurs in 0.2% of cases and is diagnosed based on a specific criteria of bilateral pulmonary infiltrates, PaO2/FiO2 ratio less than 300 mmHg, and a p/f ratio of less than 100 mmHg. Management involves strategies such as high PEEP, muscle relaxants, recruitment maneuvers, and ECMO. Mortality rates for ARDS in acute pancreatitis range from 30% to 40%. Prediction scores like LIPS, APACHE II, IL-6, and IL-8 help anticipate ARDS. This case emphasizes the rare lethality and rapid rate with which these complications develop and the need for a multidisciplinary approach in managing severe acute necrotizing pancreatitis and its complications, such as hemorrhagic shock and ARDS (Figure 1, Table 1).

Volume

118

Issue

10

First Page

S1556

Last Page

S1556

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