Hypertriglyceridaemia-induced acute pancreatitis

Case contributed by Dr Henry Knipe

Presentation

12 hours of acute onset left flank pain.

Patient Data

Age: 30 years
Gender: Female
Pancreatic tail is oedematous with surrounding fat stranding, which extends into the small bowel mesentery and greater omentum. Small volume of free fluid in the left paracolic gutter. Normal pancreatic enhancement with no evidence of pancreatic necrosis. No pancreatic duct or hepatic duct dilatation. No radiopaque gallstones.

The patient proceeded to further work-up including ultrasound that did not demonstrate cholelithiasis was well as blood tests with selected results shown:

  • Lipase: 519 IU/L (normal 8-78) 

Fasting lipid profile:

  • Cholest.    17.9H mmol/L (normal <4.0)
  • HDLC        0.4L mmol/L (normal >1.0)
  • Triglycer.   32.3H  mmol/L (normal <1.5)

The patient also denied alcohol abuse. 

Case Discussion

Hypertriglyceridaemia is one of more common non-biliary non-alcoholic pancreatitis (meaning that is quite uncommon overall!), and is the most common (~55%) cause of pancreatitis in pregnancy.

While the pathogenesis is unclear, to induce pancreatitis serum triglyceride levels have to be at least 10 mmol/L and are typically >20 mmol/L. The underlying cause of hypertriglyceridaemia is most commonly (~60%) a genetic disorder in lipid metabolism. 

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Case Information

rID: 46360
Case created: 2nd Jul 2016
Last edited: 27th Sep 2016
Inclusion in quiz mode: Included

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