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• W2977734050 abstract "Introduction: Post-procedural acute pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted complication; however, acute pancreatitis is uncommon following diagnostic endoscopy. We present a rare case of acute severe pancreatitis after ampullary biopsy during routine surveillance of a patient with Familial Adenomatous Polyposis and known duodenal adenomas. Case Report: We present a case involving a 37 year old Caucasian female with known history of Familial Adenomatous Polyposis (FAP) status post colectomy 14 years ago, with previous endoscopic evaluations showing polyposis throughout the mid and distal small bowel. The patient presented for routine surveillance of duodenal adenomas. There were greater than 20 3-5mm sessile polyps noted throughout the duodenum including a single polyp near the major papilla with the minor papilla appearing normal (Figure 1). All areas were biopsied with cold forceps (Bos. Sci. Radial Jaw 4 2.8mm) as well as the major papilla. Several hours post procedure, the patient developed severe epigastric pain, nausea, and vomiting. Upon presentation, the patient had tachycardia, tachypnea, and hypoxia requiring supplemental oxygenation. Laboratory data included: BUN 35 Creatinine 1.5 CRP 32, Amylase 1079, and Lipase 1125. On CT, the pancreas had an edematous appearance with peripancreatic fluid extending into the lesser sac confirming pancreatitis without necrosis (Figure 2). The patient was diagnosed with acute severe pancreatitis. Other causes of pancreatitis such as hypertriglyceridemia, alcohol, and cholelithiasis were ruled out. Her course was complicated by acute kidney injury, respiratory distress requiring BiPAP, antibiotics, and nasojejunal feedings with eventual improvement and discharge after 10 days.Figure 1Figure 2Discussion: Post-ERCP pancreatitis is a well described entity; however, ampullary biopsy is only rarely described as a cause for pancreatitis. Our literature review revealed only three other case reports of acute pancreatitis post endoscopy with ampullary biopsy and these cases were associated with an abnormal appearance of the ampulla. In our case, the normal appearing ampulla was biopsied as part of the current guidelines regarding patients with FAP and duodenal adenomas. Our case describes a patient with a complication of severe pancreatitis from this routine screening. Patients should be informed of this possible adverse side effect of the procedure and routine biopsy." @default.
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• W2977734050 date "2016-10-01" @default.
• W2977734050 modified "2023-09-27" @default.
• W2977734050 title "A Rare Case of Severe Acute Pancreatitis in a Patient with Familial Adenomatous Polyposis and Duodenal Adenomas Undergoing Screening Ampullary Biopsy" @default.
• W2977734050 doi "https://doi.org/10.14309/00000434-201610001-02096" @default.
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