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JAMA Surgery Clinical Challenge
August 2017

Acute Pancreatitis After Pancreaticoduodenectomy

Author Affiliations
  • 1Department of Surgery, Mount Sinai St Luke’s Roosevelt, New York, New York
  • 2Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Surg. 2017;152(8):795-796. doi:10.1001/jamasurg.2017.1597

A man in his 70s with history of pancreatic adenocarcinoma who had undergone a Whipple procedure 2 years prior to presentation came to the emergency department with a 1-day history of waxing and waning sharp abdominal pain radiating to his back. He admitted to nausea but no vomiting, fevers, or chills. He reported having normal bowel movements and passing flatus without difficulty. On examination, he was afebrile and not tachycardic. He had a well-healed abdominal midline wound. His abdomen was soft, not distended, and mildly tender diffusely, worse in the epigastrium, without rebound, guarding, or any palpable masses. His bloodwork revealed an elevated lipase level of 2842 U/L (to convert to microkatals per liter, multiply by 0.0167) without leukocytosis or any electrolyte abnormalities. Liver function test results were within normal limits. Given a history of pancreaticoduodenectomy, the patient underwent computed tomography of the abdomen and pelvis with oral and intravenous contrast for further evaluation (Figure).

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