1448 Acute Pancreatitis in a Patient With Left-Sided Diverticulitis

Abstract

INTRODUCTION: Acute pancreatitis is a leading gastrointestinal cause of hospitalization. Several conditions are associated with pancreatitis, with gallstones and chronic alcohol abuse causing approximately two-thirds of cases. In rare instances, acute pancreatitis has been associated with intraluminal or periampullary duodenal diverticulitis and right-sided colonic diverticulitis. We present a case of acute pancreatitis associated with left-sided colonic diverticulitis. CASE DESCRIPTION/METHODS: 43-year-old non-alcoholic female with history of sigmoid diverticulosis presented to the ambulatory clinic with worsening epigastric pain radiating to the neck and back. Epigastric tenderness was evident on physical examination. Initially, she was treated empirically with proton-pump inhibitor for presumed gastritis. Her symptoms persisted for one month and was associated with hematochezia. CT of the abdomen and pelvis with contrast revealed inflammatory change within proximal descending colon, with ovoid fluid distended structure consistent with acute diverticulitis and fat stranding of the pancreatic tail. She was admitted to the hospital where labs revealed serum lipase of 1202, Calcium 9.2, liver biochemical tests were within normal range. Further workup showed triglycerides and immunoglobulins were unremarkable, tissue transglutaminase reported being negative, calprotectin was elevated to 380 mcg/g. Ultrasound showed no evidence of cholelithiasis. In addition to bowel rest, she was treated with IV antibiotics for diverticulitis and IV Ringer's Lactate for pancreatitis. Later on, symptoms resolved. CT abdomen-pelvis with contrast was repeated and demonstrated resolution of the inflammatory changes in both the colon and pancreas. Outpatient endoscopy showed a small hiatal hernia, non-erosive gastritis and normal duodenum. Colonoscopy showed moderate diverticulosis in the descending colon and sigmoid colon. Gastric, duodenal and colonic biopsy did not show any abnormality. Her acute pancreatitis may be associated with diverticulitis of the proximal descending colon. DISCUSSION: There have been many cases of duodenal diverticulitis associated with acute pancreatitis. There has been one case report of acute pancreatitis associated with right-sided colonic diverticulosis. There is no case report available with any association of acute pancreatitis and left-sided diverticulitis. Pancreatitis may also be associated with left-sided diverticulitis.

An unusual case of acute pancreatitis in a patient with sigmoid diverticulitis

“…Cases have been described of acute pancreatitis in the setting of duodenal diverticulitis 6 , 7 ; however, pancreatitis secondary to colonic diverticulitis is rare. There have been cases previously reported of pancreatitis in the setting of diverticulitis at the hepatic flexure 8 and at the proximal descending colon, 9 , 10 but to our knowledge, this is the first reported case of pancreatitis secondary to sigmoid diverticulitis.…”