D0071 - Acute Pancreatitis Following a Lower Extremity Angioplasty

Tanisha Kalra, MD¹, Nodari Maisuradze, MD¹, Irina Shabanova, MD¹, Thy Vo, BS¹, Rajesh Veluvolu, MD^2
1SUNY Downstate Health Science University, Brooklyn, NY; ²SUNY Downstate Medical Center, Brooklyn, NY

Introduction: Acute pancreatitis affects a significant population globally. Usual etiologies are gallstones, alcohol, hypertriglyceridemia, medications; less frequent are trauma, hypercalcemia, infections, toxins, ischemia, anatomic anomalies, vasculitis, and idiopathic. Pancreatitis post coronary intervention is an uncommon cause with only 19 published cases in the last two decades. Being cognizant of this etiology is important given the increasing number of patients undergoing angiography.

Case Description/Methods: An 81-year-old female with hypertension, diabetes, peripheral arterial disease, prior cholecystectomy underwent left lower extremity angioplasty at an outside center. Within a few hours, she started having severe epigastric pain radiating to her back, nausea, vomiting and loose bloody stool. She presented to the emergency department 24 hours after symptom onset. Epigastric tenderness was present on exam. Labs revealed leukocytosis(24,450/µL),elevated lipase(1410 U/L),elevated creatinine(1.3 mg/dL),lactate(3.1 mmol/L), calcium 9.4 mg/dL and triglycerides 161 mg/dL. Incidentally, found to be positive for COVID-19. Normal common bile duct diameter seen on sonogram. CT angiogram of the abdomen/pelvis showed acute pancreatitis, duodenal and central small bowel enteritis. She was not on any medications known to cause pancreatitis and denied alcohol use. Patient improved with analgesics and intravenous fluids. She had no recurrence of bloody stools and hemoglobin remained stable. On day 4, she was able to tolerate a regular diet, and leukocyte count and creatinine normalized. Patient did not have any COVID respiratory symptoms, and was discharged.

Discussion: Given the temporal association to angioplasty and no other identifiable cause, acute pancreatitis was presumed to be due to the contrast used during angioplasty. Other possibilities included cholesterol embolism but no peripheral signs of cholesterol embolism were seen. Patient was an asymptomatic COVID-19 case. Although, there are case series of pancreatitis due to COVID, those were found in very sick symptomatic patients. On review of literature, cholesterol embolism was identified as a definite cause only on autopsy or laparotomy. Other possible mechanisms are: high viscosity of the contrast media leading to ischemia and necrosis, contrast causing NF-κB activation followed by epithelial damage, and vasospasm. Pancreatitis after coronary angiography is rare, nonetheless, an important differential especially if there is a temporal relationship.




Disclosures:


Tanisha Kalra, MD¹, Nodari Maisuradze, MD¹, Irina Shabanova, MD¹, Thy Vo, BS¹, Rajesh Veluvolu, MD². D0071 - Acute Pancreatitis Following a Lower Extremity Angioplasty, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.