DOI: http://dx.doi.org/10.18203/2349-2902.isj20194080

Gall stone pancreatitis in a syringomyelia patient: case report and historical review

Abel Chundankuzhiyil Mathew, Athira Poothankandi, Rahana Khader, Amina Shajahan, Linu Mohan Panakkal

Abstract


Syringomyelia is a rare neurological disorder generally regarded as chronic, characterized by slowly progressing fluid-filled cyst (syrinx) forms within the spinal cord. Here we describe the historical review of a patient suffering from syringomyelia for the past 16 years and present gastric condition- gall stone induced pancreatitis. A quadriparetic female patient who had previously undergone surgical treatment for syringomyelia with the early signs including muscle weakness and wasting (atrophy), loss of reflexes, loss of sensitivity to pain and temperature and also stiffness in back, shoulders, spinal curvature (scoliosis) presenting complains of multiple episodes of hematemesis and severe constipation since 5 days. Ultrasonography imaging and laboratory investigations revealed gallbladder stone induced acute pancreatitis also associated. The patient underwent multiple surgical interventions for syrinx removal and associated surgical complications were managed adequately. Currently, the pancreatitis was managed by laparoscopic corrections. Postoperatively, there was a prompt resolution of pancreatitis and associated gastric symptoms. In conclusion, early diagnosis of syringomyelia with magnetic resonance imaging is critical in the prophylaxis of spinal cord compression and potential neurologic injury. Surgical interventions are recommended in symptomatic cases. This case report describes clinical manifestations and management of acute pancreatitis in a chronic sufferer of syringomyelia.


Keywords


Syringomyelia, Syringo-subarachonoid shunting, Gall stone pancreatitis

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References


Mayo Clinic. Syringomyelia. 2017. Available at: https://www.mayoclinic.org/diseases-conditions/ syringomyelia/symptoms-causes/syc-20354771. Accessed on 06 August 2019

Pancreapedia. Gallstone-related pathogenesis of acute pancreatitis. 2016. Available at: https://www.pancreapedia.org/reviews/gallstone-related-pathogenesis-of-acute-pancreatitis. Accessed on 06 August 2019.

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.

Cartier T, Songi P, Perruche F, Meyniard O, Claessens YE, Dhainaut JF, et al. Normal lipase serum level in acute pancreatitis: a case report. Emerg Med J. 2006;23:701–2.

Shah AM, Eddi R, Kothari ST, Maksoud C, DiGiacomo WS, Baddour W. Acute pancreatitis with normal serum lipase: a case series. JOP. 2010;11:369–72.

Khan FY, Matar I. Chylous ascites secondary to hyperlipidemic pancreatitis with normal serum amylase and lipase. World J Gastroenterol. 2007;13:840–42.

Milhorat TH. Classification of syringomyelia, Neurosurg Focus. 2000;8(3):1–6.

Roy AK, Slimack NP, Ganju A. Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management. Neurosurg Focus. 2011;31(6):15.

Larner AJ, Muqit MMK, Glickman S. Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature. Medicine. 2002;81(1):41-50.

Samanci Y, Celik SE. Syringomyelia associated with Cervical Spondylosis: a case report. Romanian Neurosurg. 2014;21(2):220–3.

Attal N, Parker F, Tadié M, Aghakani N, Bouhassira D. Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome: a long term prospective study. J Neurol Neurosurg Psychiat. 2004;75:1025–30.

Barbaro NM, Wilson CB, Gutin PH, Edwards MS. Surgical treatment of syringomyelia. Favorable results with syringoperitoneal shunting. J Neurosurg. 1984;61:531–8.

Heiss JD, Patronas N, DeVroom HL, Shawker T, Ennis R, Kammerer W, et al. Elucidating the pathophysiology of syringomyelia. J Neurosurg. 1999;91:553–62.

Isu T, Iwasaki Y, Akino M, Abe H. Hydrosyringomyelia associated with a Chiari I malformation in children and adolescents. Neurosurg. 1990;26:591–6.

Sansur CA, Heiss JD, DeVroom HL, Eskioglu E, Ennis R, Oldfield EH. Pathophysiology of headache associated with cough in patients with Chiari I. J Neurosurg. 2003;98:453–8.

Shannon N, Symon L, Logue V, Cull D, Kang J, Kendall B. Clinical features, investigation and treatment of post-traumatic syringomyelia. J Neurol Neurosurg Psychiatry. 1981;44:35–42.

Steinbok P. Ethical considerations relating to writing a medical scientific paper for publication. Childs Nerv Syst. 1995;11:323–8.

Ventureyra EC, Tekkok IH. Syringostomy using myringostomy tube: technical note. Neurosurg. 1997;41:495–7.

Amboss. Syringomyelia. 2019. Available at: https://www.amboss.com/us/knowledge/Syringomyelia. Accessed on 07 August 2019.

Aghakhani N, Baussart B, David P, Lacroix C, Benoudiba F, Tadie M, et al. Surgical treatment of posttraumatic syringomyelia. Neurosurg. 2010;66(6):1120-7.

Batzdorf U, Klekamp J, Johnson JP. A critical appraisal of syrinx cavity shunting procedures. J Neurosurg. 1998;89:382-8.

Kim S, Choi S, Youm J, Kwon H. Syringosubarachnoid-Peritoneal Shunt Using T-Tube for treatment of post-Traumatic Syringo-myelia. J Korean Neurosurg Soc. 2012;52(1):58-61.