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

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.