Presentation
12 hours of acute onset left flank pain.
Patient Data
Pancreatic tail is edematous with surrounding fat stranding, which extends into the small bowel mesentery and greater omentum. Small volume of free fluid in the left paracolic gutter. Normal pancreatic enhancement with no evidence of pancreatic necrosis. No pancreatic duct or hepatic duct dilatation. No radiopaque gallstones.
The patient proceeded to further work-up including ultrasound that did not demonstrate cholelithiasis was well as blood tests with selected results shown:
- Lipase: 519 IU/L (normal 8-78)
Fasting lipid profile:
- Cholest. 17.9H mmol/L (normal <4.0)
- HDLC 0.4L mmol/L (normal >1.0)
- Triglycer. 32.3H mmol/L (normal <1.5)
The patient also denied alcohol abuse.
Case Discussion
Hypertriglyceridemia is one of more common non-biliary non-alcoholic pancreatitis (meaning that is quite uncommon overall!), and is the most common (~55%) cause of pancreatitis in pregnancy.
While the pathogenesis is unclear, to induce pancreatitis serum triglyceride levels have to be at least 10 mmol/L and are typically >20 mmol/L. The underlying cause of hypertriglyceridemia is most commonly (~60%) a genetic disorder in lipid metabolism.
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