124
￭ S-161 ￭
Ischemic liver cirrhosis due to acute pancreatitis
가천대 길병원 소화기 내과
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천가영, 김연석
Background: Portal vein thrombosis is a rare complication of acute pancreatitis. We present the case of a patient who developed ischemic liver disease and portal vein thrombosis during the course of acute pancreatitis. Case: A 50-year-old man was admitted to the emergency department with a chief complaint of abdominal pain that began one day prior. Laboratory analysis on admission showed the following: white cell count, 20,970/mm3 (neutrophils, 70.1%); platelet count, 307×103/mm3; hemoglobin level, 17.1 g/dL; C-reactive protein level, 0.34 mg/L; lipase level, 131 (6-51) U/L; amy- lase level, 66(30-118) U/L; AST/ALT level, 503/659(5-40) U/L. Renal function tests and chest radiograph were normal. APCT revealed a mildly en- larged pancreatic head with peripancreatic fluid. Although amylase level was normal, he was diagnosed with acute pancreatitis based on symptoms &
APCT findings. These laboratory parameters varied over the course of his admission. On hospital day 2, he showed progression of acute kidney injury (AKI) and developed anuria on hospital day 3. Despite further progression of the AKI on day 4 after admission, he recovered urination with hemodialysis. On hospital day 7, the patient complained of abdominal discomfort, and abdominal distension and ascites were observed. We performed paracentesis; results showed a transudate fluid with a serum-ascites albumin gradient of 2.0 g/dL. This suggested that the fluid collection was not an exudate due to necrotizing pancreatitis. We performed repeat APCT and diagnosed the patient with ischemic hepatitis due to portal vein thrombosis.
Anticoagulation therapy was initiated with intravenous heparin, which was later switched to warfarin. Ascites was controlled with diuretics. The pa- tient’s conditions & laboratory finding was improved and discharged. He is currently being followed as an outpatient on continued anticoagulant therapy. Conclusion: This represents a rare case of acute pancreatitis leading to portal vein thrombosis with ischemic hepatitis.
￭ S-162 ￭
Biliary Ascites Caused by Spontaneous Gallbladder Perforation
1원광대학교의과대학산본병원 내과, 2원광대학교의과대학산본병원 영상의학과
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김남호
1, 장재훈
1, 손승현
1, 김 훤
1, 조원석
1, 홍누리
2, 손 원
1, 손영우
1, 김용성
1Introduction: Biliary ascites is a rare complication caused by spontaneous perforation of biliary system. Most cases were reported in children with congenital anomalies, or trauma, but rarely in adults. Herein, we report a case of biliary ascites with spontaneous gallbladder perforation in elderly patient. Case: A 87-year-old woman was admitted with the presentation of abdominal pain on epigastric area which began one hour before admission.
She had no other past history except hypertension. Her vital signs were stable. Epigastric tenderness was evident on physical examination. On labo- ratory tests, WBC count was 12000 cells/uL, with amylase 1009U/L, and lipase 5730U/L. Abdominal CT scan showed pancreatic parenchymal infiltra- tion with peripancreatic swelling. She was firstly diagnosed with acute pancreatitis, and treated with hydration and fasting. But, even after normal- ization of amylase and lipase level after several days, she still complained of worsened abdominal tenderness. We performed paracentesis to determine the cause of abdominal pain. Ascitic fluid was orange in color with abundant leukocytes. She was diagnosed with spontaneous peritonitis caused by in- fected ascitic fluid. Antibiotics was applied to control infection, however, the amount of ascites was increased. On the second paracentesis, the color of ascitic fluid was changed to brownish color, and we checked for the total bilirubin in the fluid which turned out to be 28.3 mg/dL. On follow up abdomi- nal CT scan, there was a focal wall defect of the gall bladder without evidence of cholecystitis or abnormality in the biliary system. Due to the patient’s old age, we decided to keep on medical therapy which continued for more than 2 weeks. Finally, she was recovered and discharged without operation or other surgical procedure. Conclusions: In our case report, the initial laboratory results and clinical features were suggestive of ascites due to a compli- cation of acute pancreatitis. But, from the ascitic fluid analysis, we determined peritoneal bilirubin level which led to the diagnosis of biliary ascites. A high index of suspicion is required in case of unusual presentation of ascites without a certain cause.
