A rare case of acute destructive pancreatitis in a patient with chronic kidney disease on peritoneal dialysis: diagnostic and treatment challenges
https://doi.org/10.15825/1995-1191-2023-4-139-149
Abstract
Patients with chronic kidney disease are susceptible to developing acute pancreatitis. We present a rare clinical case of acute pancreatitis with the formation of pancreatic necrosis in a patient on peritoneal dialysis (PD), debuted with PD–associated peritonitis. On hospitalization, there were no diagnostic criteria for acute pancreatitis; treatment for dialysis peritonitis was ineffective. Repeated ultrasound examination revealed signs of diffuse changes in the pancreas and multi-chamber formation of the small pelvis. Refractory peritonitis, inadequate ultrafiltration, and unclear nature of formation in the pelvic were the grounds for diagnostic laparoscopy and removal of the peritoneal catheter. Abdominal inspection revealed spots of stearin necrosis over the entire surface of the peritoneum and the greater omentum; in the pelvis there were adhesions between the uterus and the rectum. Development of pancreonecrosis was confirmed by abdominal CT scan. Treatment of acute pancreatitis was without effect, type 2 myocardial infarction developed, and with increasing symptoms of multiple organ failure, death occurred.
About the Authors
V. A. Stepanov
Vladimirsky Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Moscow
O. N. Vetchinnikova
Vladimirsky Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Olga Vetchinnikova
61/2, Shchepkina str., Moscow, 129110
Phone: (916) 532-49-00
References
1. Andrusev AM, Peregudova NG, Shinkarev MB, Tomilina NA. Kidney replacement therapy for end Stage Kidney disease in Russian Federation, 2016–2020. Russian National Kidney Replacement Therapy Registry Report of Russian Public Organization of Nephrologists «Russian Dialysis Society». Nephrologу and Dialуsis. 2022; 24 (4): 555–565. (In Russ, English abstract). doi: 10.28996/2618-9801-2022-4-555-565.
2. Pitrone F, Pellegrino E, Mileto G, Consolo F. May pancreatitis represent a CAPD complication? Report of two cases with a rapidly evolution to death. Int J Artif Organs. 1985; 8 (4): 235.
3. Manga F, Lim C-S, Mangena L, Guest M. Acute pancreatitis in peritoneal dialysis: a case report with literature review. European Journal of Gastroenterology & Hepatology. 2012; 24 (1): 95–101. doi: 10.1097/MEG.0b013e32834d4bcc.
4. Hou SW, Lee YK, Hsu CY, Lee CC, Su YC. Increased risk of acute pancreatitis in patients with chronic hemodialysis: a 4-year follow-up study. PLoS One. 2013; 8 (8): e71801.
5. De Tersant M, Kwon T, Macher M-A, Maisin A, Deschênes G, Niel O. Hypernatremia and acute pancreatitis in chronic kidney disease: back to the salt mines. Questions. Pediatr Nephrol. 2017. doi: 10.1007/s00467-0173821-2.
6. Lee YC, Hung SY, Wang HH, Wang HK, Lin CW, Chang MY et al. Different risk of common gastrointestinal disease between groups undergoing hemodialysis or peritoneal dialysis or with non-end stage renal disease. A Nationwide population-based cohort study. Medicine. 2015; 94 (36): e1482. doi: 10.1097/MD.0000000000001482.
7. Bruno MJ, van Westerloo DJ, van Dorp WT, Dekker W, Ferwerda J, Tytgat GN et al. Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology. Gut. 2000; 46 (3): 385– 389. doi: 10.1136/gut.46.3.385.
8. Lankisch PG, Weber-Dany B, Maisonneuve P, Lowenfels AB. Frequency and severity of acute pancreatitis in chronic dialysis patients. Nephrol Dial Transplant. 2008; 23: 1401–1405. doi: 10.1093/ndt/gfm769.
9. Chen HJ, Wang JJ, Tsay WI, Her SH, Lin CH, Chien CC. Epidemiology and outcome of acute pancreatitis in endstage renal disease dialysis patients: a 10-year national cohort study. Nephrol Dial Transplant. 2016; 1–6. doi: 10.1093/ndt/gfw400.
10. Ostryy pankreatit. Klinicheskie rekomendatsii [Acute Pancreatitis. Clinical Guidelines]. 2020. 66 p. http://obshhestvo-xirurgov.rf/stranicapravlenija/unkr/urgentnajaabdominalnajahirurgija/nacionalnyeklinicheskie-rekomendaci-po-ostromu-pankreatitu.html. (In Russian).
11. Ostroumova OD, Akimova ES, Kochetkov AI. Drug-induced acute pancreatitis: pathogenetic mechanisms. Siberian Medical Review. 2021; 3: 35–43. doi: 10.20333/25000136-2021-3-35-43.
12. Vidal E, Alberici I, Verrina E. Italian Registry of Pediatric Chronic Dialysis. Acute pancreatitis in children on chronic maintenance dialysis. Pediatr Nephrol. 2019; 34 (9): 1501–1512. doi: 10.1007/s00467-018-4043-y.
13. Revishvili ASh, Sazhin VP, Olovyannyj VE, Zakharova MA. Current trends in emergency abdominal surgery in the Russian Federation. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020; 7: 6–11. (in Russ. English abstract). doi: 10.17116/hirurgia20200716.
14. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Acute Pancreatitis Classification Working Group Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62 (1): 102–111.
15. Ukai T, Shikata S, Inoue M, Noguchi Y, Igarashi H, Isaji S et al. Early prophylactic antibiotics administration for acute necrotizing pancreatitis: a meta-analysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2015; 22: 316–321. doi: 10.1002/jhbp.221.
Supplementary files
Review
For citations:
Stepanov V.A., Vetchinnikova O.N. A rare case of acute destructive pancreatitis in a patient with chronic kidney disease on peritoneal dialysis: diagnostic and treatment challenges. Russian Journal of Transplantology and Artificial Organs. 2023;25(4):139-149. https://doi.org/10.15825/1995-1191-2023-4-139-149
Views:
346
Email this article 