Rehan Rafiq, MD, FACG1, Ahmad Rafiq2; 1BJC Medical Group, St. Louis, MO; 2MICDS, St. Louis, MO
Introduction: Acute pancreatitis, a common clinical diagnosis, has a reported incidence range of 4.9 to 35 people per 100,000(1). Gallstones and alcohol are the most common causes of pancreatitis. Gallstones account for 40-75% of cases of acute pancreatitis(2). Alcohol causes 25-30% of cases(3). Pancreatitis secondary to angiographic contrast is believed to cause pancreatitis in less than 0.1% of all angiograms performed(4). Review of literature shows 5 cases of contrast-induced pancreatitis, with 2 of them in patients due to contrast used in dialysis catheter. We present a case of acute pancreatitis in a lady after cardiac catheterization secondary to angiographic dye.
Methods: A 76 year-old female with history of coronary artery disease and history of CABG presented with signs and symptoms of unstable angina. Cardiac catheterization was performed using 150 ml of ioversol (Optiray 350) injection. Angiographic pictures revealed 90% ostial LAD stenosis, which was successfully treated with placement of a coronary stent. Her chest pain improved after procedure, but she developed diffuse abdominal pain radiating to the back . Physical exam showed diffuse abdominal tenderness. Family history was negative for pancreatitis. Skin exam showed no evidence of cholestrol emboli. Blood work showed an amylase level of 828 U/L and lipase of 1637 U/L more than 3 times the upper limit of normal. Triglyceride level was 266 mg/dl. CT showed findings of acute pancreatitis, and US showed no evidence of gallstones or sludge. She was not taking medications implicated in causation of acute pancreatitis. She was diagnosed with mild acute pancreatitis based upon Atlanta classification and was treated with aggressive intravenous hydration and analgesia. Symptoms improved. She tolerated diet and was discharged. Discussion: Pancreatitis after coronary intervention is reported in few case reports. Proposed mechanisms include contrast media injury and cholesterol crystal embolization(5-8). Jin et al. demonstrated that exposure to radiocontrast agents induce pancreatitis by activation of nuclear factor -kB, calcium signaling and calcineurin(9). Contrast agents are also known to cause vasospasm, a plausible cause of pancreatitis in patients undergoing coronary angiograms. Contrast-induced pancreatitis was seen in a patient with coronary artery disease and ESRD on hemodialysis, suggesting atherosclerosis is a possible contributing factor. Further studies are needed to clearly define the exact pathophysiology of this disorder.
Contrast Induced Mild Acute Pancreatitis.
Disclosures: Rehan Rafiq indicated no relevant financial relationships. Ahmad Rafiq indicated no relevant financial relationships.