review of literature on clinical pancreatology - The Pancreapedia

(before ERCP), serum TAP was detectable in all patients. One- and 2-hour post-ERCPserum TAP concentrations remained elevated, whereas these concentrations significantlydeclined at 4 hours. Urine TAP showed the same behavior as serum TAP; detectable urineconcentrations were present in 6 (9 %) <strong>of</strong> the 65 patients before ERCP and after 2 hours,whereas at 4 and 6 hours, all patients had no detectable urinary TAP concentrations. Meanserum trypsinogen concentrations were slightly below the upper reference limit (57 ng/mL)before ERCP examination, and then they were significantly increased thereafter. BeforeERCP, there were no significant differences in the serum and urinary levels <strong>of</strong> the enzymesstudied among the different final diagnoses. Serum and urine TAP levels and serumtrypsinogen concentration showed no significant differences between patients whodeveloped acute pancreatitis after ERCP and those who did not in any <strong>of</strong> the time intervalsstudied. The same behaviour was present between patients who were treatedprophylactically with gabexate and those who did not receive the drug. Regarding theprimary end point, all patients had detectable concentrations <strong>of</strong> serum and urine TAP beforeERCP, and no differences in basal TAP values were observed among patients with lithiasis<strong>of</strong> the common bile duct, those with benign stenosis <strong>of</strong> the common bile duct, those withchronic pancreatitis, and those with common bile duct pancreatic neoplasms. The serumconcentrations <strong>of</strong> TAP remained elevated for the subsequent observation period (at 1 and 2hours) and then progressively declined at 3, 4, and 6 hours. This observation confirms dataon the low sensitivity <strong>of</strong> serum TAP in diagnosing acute pancreatitis because TAP is rapidlyeliminated from the circulation. Urine TAP gave the same results [216].Ischemic pancreatitisAcute pancreatitis due to pancreatic ischemia is a rare condition. In a case report it wasdescribed a 57-year-old male who developed an acute necrotizing pancreatitis after runninga marathon and visiting a sauna the same evening, with an inadequate fluid and foodconsumption during both events. Pancreatic ischemia imposed by mechanical and physicalstress and dehydration can induce the development <strong>of</strong> acute pancreatitis. Separately, thesefactors are rare causes <strong>of</strong> ischemic acute pancreatitis. But when combined, as in thisparticular case, the risk <strong>of</strong> an acute necrotizing pancreatitis cannot be neglected [217].Drug-induced pancreatitisIt was reported a case <strong>of</strong> a 35-year-old patient with acute pancreatitis after administration <strong>of</strong>ceftriaxone. She was given ceftriaxone (2g/day) for 9 days because <strong>of</strong> diverticulitis <strong>of</strong> thecolon but was admitted to our hospital again because <strong>of</strong> epigastralgia 12 days after the firstadministration <strong>of</strong> ceftriaxone. Laboratory examination showed markedly elevated serumamylase, and CT scan demonstrated findings consistent with acute pancreatitis, in additionto sludge in the common bile duct and gall bladder, which was not identified before theadministration <strong>of</strong> ceftriaxone. One may be aware <strong>of</strong> the fact that administration <strong>of</strong> ceftriaxonesometimes results in the formation <strong>of</strong> biliary sludge and can cause severe adverse eventssuch as cholecystitis and pancreatitis, not only in children, but also in adult patients [218].Infective pancreatitisAscarisAscaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides canoccasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. It waspresent a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrentpancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatographyperformed during an acute attack <strong>of</strong> pain [219].