DOI: http://dx.doi.org/10.18203/2349-2902.isj20200836

Acute pancreatitis following coronary angiography: case report and review of contrast-induced pancreatitis

Jasmine J. Mui, Raphael Shamavonian, Kim Chi Phan Thien

Abstract


Acute pancreatitis is a common surgical presentation with a multitude of causative factors. While the pathogenesis is not completely understood, new potential triggers have been described in recent literature. Contrast-induced pancreatitis is one of these rare phenomena. We present a case of acute pancreatitis in a patient who underwent coronary angiography and discuss the suspected pathogenesis behind contrast-induced pancreatitis. A 65-year-old man with background of cholecystectomy and UroLift procedure underwent two-stage elective coronary angiography following an episode of angina. He had been started on perindopril, rosuvastatin, aspirin and clopidogrel the week prior following first-stage percutaneous transluminal angioplasty of the right coronary artery. The patient underwent uncomplicated angiography, receiving 120 ml of Omnipaque 350. After transfer to the ward, he complained of progressive epigastric pain and nausea. On examination, the patient was afebrile, haemodynamically stable and tender in the epigastrium. His lipase was 888 U/l. Liver ultrasound showed an absent gallbladder but no other abnormalities. Total cholesterol was 2.7 mmol/l and IgG subclasses within normal range. There was no indication to perform an EUS. His symptoms resolved and his lipase normalised within three days. Although contrast-induced pancreatitis is rare, it should be considered in patients exposed to intravenous contrast who manifest symptoms. It occurs due to reduced capillary flow resulting from increased viscosity of radiographic contrast. The rate of invasive coronary investigations continues to rise with cardiovascular disease affecting one in five Australians. Therefore contrast-induced pancreatitis will likely become more common in this population hence it is important to be recognised.


Keywords


Contrast-induced pancreatitis, Coronary angiography, Pancreatitis

Full Text:

PDF

References


Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33(4):323-30.

Fagenholz PJ, Ferna C, Harris NS, Pelletier AJ, Camargo Jr CA. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas. 2007;35(4):302-7.

Forsmark CE, Vege SS, Wilcox M. Acute Pancreatitis. N Eng J Med. 2017;376(6):589-9.

Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007;5(6):648-61.

Chin WS, Ng R. Acute fulminant pancreatitis following ventriculography. Cardi Inter Radiol. 1981;4(2):108-9.

Farooq AU, Amjad W, Yasin H. Rare complication of coronary angiography: contrast-induced acute pancreatitis. Am J Ther. 2017;24(6):771-2.

Dalal JJ, Digrajkkar A. Contrast induced acute pancreatitis following coronary intervention. IHJ Cardio Case Rep. 2017;1(2):109-10.

Gorges R, Ghalayini W, Zughaib M. A case of contrast-induced pancreatitis following cardiac catheterization. J Invasive Cardiol. 2013;25:203-4.

Kheda MF, Szerlip HM. Two cases of iodixanol-induced pancreatitis. NDT plus. 2008;1(5):296-9.

Schmidt J, Hotz HG, Foitzik T, Ryschich E, Buhr HJ, Warshaw AL, et al. Intravenous contrast medium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat. Annal Surg. 1995;221(3):257.

Aspelin P. Effect of ionic and non-ionic contrast media on whole blood viscosity, plasma viscosity and hematocrit in vitro. Acta Radiol Diag. 1978;19(6):977-89.

Jin S, Orabi AI, Le T, Javed TA, Sah S, Eisses JF, et al. Exposure to radiocontrast agents induces pancreatic inflammation by activation of nuclear factor-κB, calcium signaling, and calcineurin. Gastroenterology. 2015;149(3):753-64.