P4388 - Hepatic Steatosis and Hemorrhagic Pancreatitis: A Deadly Duo

Javed Jagroo, MBBS¹, Omar Oudit, DO², Jamal Perry, MD², Emad Tawadros Boshra, MD², Derrick Cheung, MD²
1Brookdale University Hospital Medical Center, Ozone Park, NY; 2Brookdale University Hospital Medical Center, Brooklyn, NY

Introduction: Pancreatitis may cause disruption of pancreatic microcirculation in its severe forms. This leads to development of hemorrhagic pancreatitis(HP),a rare complication with incidence between 1-23% and fatality rates approaching 50%.

Case Description/

Methods: A 43 year old female with a history of Alcohol use disorder presented with abdominal pain and vomiting of unclear duration. Labs revealed elevated White blood cell count (WBC), elevated INR, Acute kidney injury (AKI) and lactic acidosis. Computed tomography(CT) of the chest, abdomen and pelvis(CAP) showed hepatic steatosis but no acute findings. She was intubated, aggressively resuscitated with fluids and given broad-spectrum antibiotics. Diagnostic laparoscopy was positive only for severe hepatic steatosis. Testing for Serum Volatiles was negative and her acidosis improved with fluid resuscitation. She remained intubated and her AKI progressed, requiring Hemodialysis. 9 days later she developed a rise in WBC with intermittent fevers. Infectious work up was unremarkable. CT CAP showed an enlarged pancreas with fat stranding near the tail and fluid in the left pericolic gutter concerning for acute pancreatitis. The next day she became hemodynamically unstable and repeat Hemoglobin (Hgb) was 3.2 g/dl. CT Angiogram CAP revealed a new 19 cm hematoma within the abdomen. She underwent emergent exploratory laparotomy where a large hematoma at the greater curvature of the stomach and transverse colon mesentery with pancreatic capillary bleeding, saponification and necrosis were noted.

Discussion: HP is due to bleeding from pseudoaneurysms, pseudocysts, pancreatic necrosis or due to trauma. It Is more common in middle aged adults with chronic heavy alcohol use. Fatty Liver has also been recognized as a risk factor for pancreatitis and is associated with more severe forms of the disease, local complications and organ failure leading to death. Fatty infiltration of the pancreas itself disrupts tissue function. Future imaging techniques may help measure fat deposits and aid with risk stratification so that appropriate resuscitation efforts take place. Careful monitoring of Hgb, electrolytes and hemodynamic status in these patients may help with early detection. CT or MRI are helpful in identifying the etiology for bleeding but exploratory laparotomy is the gold standard for diagnosing and helping to control bleeding. Endovascular techniques are appropriate treatment options for patients who are hemodynamically stable or with smaller pseudoaneurysms.


Figure: Comparison of Patient's Laboratory Values from Day 1, 8 and 9 of Hospitalization.

Disclosures:
Javed Jagroo indicated no relevant financial relationships.
Omar Oudit indicated no relevant financial relationships.
Jamal Perry indicated no relevant financial relationships.
Emad Tawadros Boshra indicated no relevant financial relationships.
Derrick Cheung indicated no relevant financial relationships.

Javed Jagroo, MBBS¹, Omar Oudit, DO², Jamal Perry, MD², Emad Tawadros Boshra, MD², Derrick Cheung, MD². P4388 - Hepatic Steatosis and Hemorrhagic Pancreatitis: A Deadly Duo, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.