August 8, 1994

Atheromatous Embolization Resulting in Acute Pancreatitis After Cardiac Catheterization and Angiographic Studies

Author Affiliations

From the Department of Internal Medicine, University of Iowa, College of Medicine, Iowa City. Dr Orvar is now with Sjukrahusid Akranesi, Akranes, Iceland.

Arch Intern Med. 1994;154(15):1755-1761. doi:10.1001/archinte.1994.00420150131013

Acute pancreatitis has a spectrum from mild disease to severe organ destruction resulting in multiple system organ failure. In this study, we report data from 21 680 discharge summaries during a 10-year period of patients who had undergone trans-abdominal angiographic procedures in whom the diagnosis of pancreatitis was noted in the discharge coding. We detected 39 patients in whom pancreatitis was coded during the same hospitalization, but only nine patients had no other risk factors for pancreatitis other than the temporal relation with the angiographic procedure. Three of these nine patients died of complications caused by pancreatitis. All of the patients with poor outcomes in this report fulfilled more than three Ranson criteria within 48 hours of the original angiographic procedure. Abdominal imaging with ultrasound or computed tomography was abnormal in all the patients who fulfilled more than three Ranson criteria. The histology from the surgical procedures or the autopsies performed on the three patients who died showed extensive cholesterol embolization primarily to the visceral organs. Extensive pancreatic necrosis was evident in these patients. We conclude that acute pancreatitis after transabdominal angiographic procedures is a rare but a potential fatal event. The prognosis from this event is partially predicted by the Ranson criteria that are evident within the first 48 hours.

(Arch Intern Med. 1994;154:1755-1761)