Anadolu Gastroenteroloji Günleri 2021 Konya Bildiri Özetleri

PP04
Hereditary angioedema and pancreatitis: two diseases that should remind each other
Rashad Ismayilov 1 , Ulkar Ismayilova 2 , Onur Keskin 3
1 Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
2 Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
3 Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Rarely, cases of acute pancreatitis associated with HAE have been reported and the possible pathogenetic mechanism
is thought to be obstruction of the pancreatic duct or ampulla of Vater. In this letter, we presented a case of acute
pancreatitis interrelated HAE and discussed the noteworthy points.
A 27-year-old female diagnosed with type 1 HAE on human C1-esterase inhibitor (C1-INH) therapy, presented with
hand swelling, abdominal pain, nausea, and vomiting. The patient did not smoke or drink alcohol and had no history
of gallstone, drug use, or abdominal trauma. Laboratory investigation revealed, white blood cells were 12.6x103/µL
(4.1-11.2) with 11.7x103/µL (1.8-6.4) neutrophils, liver function tests were normal, serum amylase 565 U/L (28-
100), lipase 740 U/L (<67), corrected calcium 8.77 mg/dL (8.8-10.6), triglyceride 61 mg/dL (<150), IgG4 0.17 g/L
(0.03-0/86), and C-reactive protein was 4.29 mg/dL (0-0.8). Abdominal computed tomography showed findings
consistent with acute pancreatitis and edematous wall thickening in the small intestines (Fig. 1).
Abdominal pain is one of the most common manifestations of HAE but HAE-associated acute pancreatitis is limited
to case reports. Indeed, pancreatic enzyme levels are not routinely checked in HAE attacks, and the exact prevalence
of acute pancreatitis in these patients is unknown. However, according to both the previous and our case, it can be
said that in patients with HAE, the abdominal pain which persisted, radiated to the back, or accompanied by nausea
or vomiting may be a precursor to acute pancreatitis.
On the other hand, Aksoy et al. reported a case who presented with idiopathic recurrent pancreatitis attacks and
was eventually found to have HAE. They notified that their patients developed chronic pancreatitis in a short time.
Therefore, in idiopathic recurrent pancreatitis, the attack character and skin findings should be questioned well, and
it should be remembered that this may be caused by HAE.
Keywords: Hereditary angioedema, abdominal pain, nausea, vomiting, pancreatitis.
Figure 1
Abdominal computed tomography. An edematous appearance in the pancreatic parenchyma, diffuse density increase in the peripancreatic adipose
tissue and mesentery, and intra-abdominal diffuse free fluid were detected. Necrosis was not observed.
BİLDİRİ ÖZETLERİ
23