Acute Pancreatitis with Abdominal Bloating and Normal Transabdominal Ultrasound

Silvikarina Erfanti Dewi Halim(1),


(1) Division of Internal Medicine, Eka Hospital, Pekanbaru
Corresponding Author

Abstract


Acute pancreatitis (AP) is an inflammatory disorder of the pancreas, and its correct diagnosis is an area of interest for clinicians. A 44-year-old man, presented with bloating for 1 month and getting worsened 1 day before admission to emergency room (ER), accompanied by discomfort in the upper left abdomen. The patient had abdominal distension, no vomiting or severe abdominal pain. Ultrasonography (USG) transabdominal revealed polyp gallbladder, no stone or pancreatitis. Magnetic resonance imaging (MRI) 2 months before at the ER, showed multiple stone in gallbladder and normal pancreas. Leukocytes 15 x 103/L, serum glutamic pyruvic transaminase (SGPT) 262, serum glutamic oxaloacetic transaminase (SGOT) 249, gamma glutamyl transferase (GGT) 1369 U/L, total bilirubin (TBIL) 2.44, direct bilirubin (DBIL) 2.08, lipase 14,690 U/L, amylase 3,693 U/L. Patient refused computerized tomography scan (CT scan) or MRI repeated, based on Atlanta criteria, abdominal discomfort with high amylase/lipase and a history of gallstones, the diagnosis was made. After 3 days, SGPT 44, SGOT 19, GGT 732 U/L, lipase 46 U/L, amylase 38 U/L. Based on Atlanta classification, AP diagnosed if at least 2 of the following 3 criteria are fulfilled: abdominal pain, serum lipase or amylase at least 3x the upper limit of normal (ULN) or characteristic findings on imaging. Gallstones are the most cause of AP. Abdominal bloating in this patient couldn’t be explained by common causes, such as ascites, bowel edema, hematoma, ileus which led us to suspect pancreatitis. CT scan contrast or MRI was essential in patients with normal USG and no classic sign abdominal pain.


Keywords


acute pancreatitis; abdominal bloating; normal transabdominal ultrasound

References


Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES,

Williams JL, et al. Burden and cost of gastrointestinal, liver,

and pancreatic diseases in the United States: update 2018.

Gastroenterology 2019;156:254-72.

Vege SS, Yadav D, Chari ST. Pancreatitis. GI Epidemiology.

Talley NJ, Locke GR, Saito YA (ed): Blackwell Publishing,

Malden, MA. 2007; DOI:10.1002/9780470692189.

Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford

J, Freeny P, et al. Guidelines for the management of acute

pancreatitis. J Gastroenterol Hepatol 2002;17 Suppl:S15-39.

Malagelada JR, Accarino A, Azpiroz F. Bloating and

abdominal distension: old misconceptions and current

knowledge. Am J Gastroenterol 2017;112:1221–31.

Roberts SE, Morrison-Rees S, John A, Williams JG, Brown

TH, Samuel DG. The incidence and etiology of acute

pancreatitis across Europe. Pancreatology 2017;17:155–65.

Yadav D, Lowenfels AB. Trends in the epidemiology

of the first attack of acute pancreatitis: a systematic

review. Pancreas 2006;33:323–30.

Nesvaderani M, Eslick GD, Vagg D, Faraj S, Cox

MR. Epidemiology, etiology, and outcomes of acute

pancreatitis: a retrospective cohort study. Int J Surg 2015;23(Pt

A):68–74.

Forsmark CE, Baillie J; AGA Institute Clinical Practice and

Economics Committee; AGA Institute Governing Board.

AGA Institute technical review on acute pancreatitis.

Gastroenterology 2007;132:2022-44.

Riela A, Zinsmeister AR, Melton LJ, DiMagno EP. Etiology,

incidence, and survival of acute pancreatitis in Olmsted

County, Minnesota USA. Gastroenterology 1991;100:A296.

Moreau JA, Zinsmeister AR, Melton LJ 3rd, DiMagno EP.

Gallstone pancreatitis and the effect of cholecystectomy: a

population-based cohort study. Mayo Clin Proc 1988;63:466-

Lerch MM, Saluja AK, Rünzi M, Dawra R, Saluja M, Steer

ML. Pancreatic duct obstruction triggers acute necrotizing

pancreatitis in the opossum. Gastroenterology 1993;104:853-

Tenner S, Baillie J, DeWitt J, Vege SS; American College

of Gastroenterology. American College of Gastroenterology

guideline: management of acute pancreatitis. Am J

Gastroenterol 2013;108:1400–15.

Brizi MG, Perillo F, Cannone F, Tuzza L, Manfredi R. The role

of imaging in acute pancreatitis. Radiol Med 2021;126:1017–

Mari A, Backer FA, Mahamid M, Amara H, Carter D, Boltin

D. Bloating and abdominal distension: clinical approach and

management. Adv Ther 2019;36:1075–84.

Murray WJ. Massive gastric distention in acute pancreatitis--a

report of two cases. Postgrad Med J 1984;60:631-3.


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DOI: 10.24871/2432023270

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