Page 47 - World Journal of Laparoscopic Surgery

CASE REPORT
Postoperative Acute Pancreatitis in a Patient Who Underwent

Laparoscopic Cholecystectomy: A Case Report

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Krishna T Challa , Pedro G Canchari , Medally P Gomez , Satheesh B Arja , Mirela Ponduchi 5
AbstrAct
Laparoscopic cholecystectomy (LC) is a widely performed procedure worldwide, and it is one of the safest surgical interventions, with few
short- and long-term complications. The presentation of post-LC acute pancreatitis (AP) is quite rare and with few reports over time. This case
report relates the case of a 34-year-old woman who, 12 days after surgery, presented with AP with no other apparent cause, in addition to which
a right renal mass was found incidentally. This case presents us with a rare complication of a fairly safe surgical procedure; however, it should
serve to carry out a good follow-up of postoperative patients in the first weeks above all in order to prevent complications.
Keywords: Abdominal pain, Acute pancreatitis, Cholecystectomy, Gallstones.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1435

IntroductIon 1 Department of Medicine and Research, Avalon University School of
Laparoscopic cholecystectomy (LC) is a highly used surgical Medicine, Willemstad, Curacao, Netherlands
procedure around the world, showing a significant increase in the 2 Department of Medicine and Research, Sociedad Científica de San
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last decades. South Africa showed a 28% increase in procedures Fernando, Facultad de Medicina, Universidad Nacional Mayor de San
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performed between 2009 and 2013 compared to 2004 and 2008, Marcos, Lima, Peru
while New York had an annual increase of 1.3% between 1995 and 3 Facultad de Medicina, Universidad Continental, Huancayo, Peru
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2013. Among the reasons for carrying out the procedure, about 4 Avalon University School of Medicine, Willemstad, Curacao, Netherlands
70% of LC is due to a case of calculous cholecystitis, followed 5 Department of Internal Medicine, St. Lukes Hospital and Mountain
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by biliary colic, acalculous cholecystitis, among others. The Vista Medical Center, Mesa, Arizona, United States
procedure is quite safe, and it presents less than 15% complications, Corresponding Author: Krishna T Challa, Department of Medicine and
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between intraoperative and postoperative. Among the most Research, Avalon University School of Medicine, Willemstad, Curacao,
common complications, we have the conversion of LC to open Netherlands, Phone: +1 3313156693, e-mail: krishnatj111@gmail.com
cholecystectomy, which is the most frequent complication, How to cite this article: Challa KT, Canchari PG, Gomez MP, et al.
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followed by bile leak and bile duct injury; at the postoperative Postoperative Acute Pancreatitis in a Patient Who Underwent
level, complications are rare and at the level of this rarity, and the Laparoscopic Cholecystectomy: A Case Report. World J Lap Surg
most common is surgical wound infections and hernias. 3 2021;14(1):48–51.
Acute pancreatitis (AP) is one of the most frequent causes of Source of support: Nil

hospitalization; there was an increase of 13% in cases from 2002 Conflict of interest: None
to 2005 to 2009 to 2012; and within its causes, it is more frequently
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related to gallstones and alcohol abuse. Patients with smaller
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gallstones are those at higher risk of developing pancreatitis. Post-LC drugs. The initial lab workup of the patient showed Hb of 11.8 g/
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AP is a rare entity, and it has been reported in a cohort in 1997, where dL, WBC of 6.2 × 10 /mm , platelets of 290 × 10 mcL, creatinine of
it was seen that 40 patients out of a cohort of around 10,000 patients 0.8 mg/dL, alanine transaminase (ALT)/aspartate transaminase (AST)
presented this condition, of which eight of them occurred after an of 1000/62 units, alkaline phosphatase (ALP) of 177 IU/L, Albumin
LC conversion to open surgery, while only five patients presented of 2.9 g/dL, Ca of 7.9 mg/dL, and urine analysis is significant for 3+
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AP before 10 days after the surgery. The objective of this study is blood and 1+ protein. The abnormal liver functions and RUQ pain
to report the case of a woman who underwent LC for calculous are indicated for Ultrasound of the abdomen. Ultrasound showed
cholecystitis, who presented a picture of AP 12 days after surgery. diffusely enlarged liver parenchyma, gallstones (Fig. 1), and 2.5 mm
thickened gallbladder. There are no findings of pericholecystic
fluid. Murphy’s sign is absent. The common bile duct measures
cAse descrIptIon 5 mm in the porta hepatis. The right kidney measures 10.7 cm
This is a 34-year-old obese female patient who presented to our with a 3.5 × 2.5 × 3.4 cm complex lesion with areas of solid and
emergency department (ED) with severe abdominal pain in the right cystic change and thick septation. The Ultrasound of the abdomen
upper quadrant (RUQ) radiating to the back and epigastric region. confirmed the diagnosis of cholelithiasis and the complex lesion of
The pain started a day ago and did not get better with Tylenol. The the kidney, and RBC in the urine indicated for MRI of the abdomen.
patient denies fever, chills, nausea, or vomiting but notifies mild MRI of the abdomen showed a heterogeneous slightly enhancing
diaphoresis. In the ED, the vitals and temperature of the patient are lesion in the superior pole of the right kidney measuring 28 × 31 mm
normal. The patient denies any use of alcohol, smoking, and illicit (Fig. 2). The nature of the right kidney mass is indicated for biopsy

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