Pancreatic-type hyperamylasemia and hyperlipasemia secondary to ruptured ovarian cyst: a case report and review of the literature

Background: Although salivary-type hyperamylasemia is known to occur with ovarian pathologies such as salpingitis and adenocarcinoma, pancreatic-type hyperamylasemia and hyperlipasemia are considered to be highly specific for pancreatitis. Objectives: To discuss the interpretation of hyperamylasemia in the context of acute abdominal pain, implications for management, and to review the literature relating to non-pancreatic causes of hyperamylasemia and hyperlipasemia. Case Report: We present the case of a 25-year-old woman who presented with an acute abdomen and a markedly elevated pancreatic-type amylase and lipase in whom acute pancreatitis was suspected. Further investigations showed that the underlying pathology was actually a ruptured ovarian cyst causing massive intra-abdominal hemorrhage and necessitating emergency laparotomy. Conclusions: This case represents an initial report of pancreatic-type hyperamylasemia and hyperlipasemia occurring with ovarian pathology and hemoperitoneum. Although these derangements may have been secondary to peritoneal irritation, this case raises the possibility that ovarian tissue is able to secrete large amounts of pancreatic-type amylase and lipase in addition to salivary-type amylase. Clinicians should be aware that simultaneous elevations of both enzymes are not necessarily pathognomic of acute pancreatitis.     

经内镜逆行胰胆管造影术后急性胰腺炎与高淀粉酶血症对比观察

目的 比较经内镜逆行胰胆管造影术(ERCP)后急性胰腺炎(PEP)与高淀粉酶血症(PEHA)患者的临床特点及影响因素,为预防病情进展提供依据。 方法 选取武汉大学人民医院2017年1月-2019年8月住院行ERCP的患者117例,所有患者术前均预防性使用双氯芬酸钠栓塞肛。术后发生PEHA组77例,PEP组40例,比较2组患者临床特点及影响因素。符合正态分布的计量资料2组间比较采用t检验;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验;采用多因素logistic回归分析PEP的独立影响因素。结果 术前ALP(Z=-2.518,P=0.012)、GGT(Z=-2.313,P=0.021)、TBil(Z=-2.978,P=0.003)、DBil(Z=-3.069,P=0.002)水平及术中是否行导丝进入胰管检查(χ2=4.176,P=0.041)在两组之间差异显著。进一步logistic回归分析结果显示,导丝进入胰管次数≥3次[优势比(OR)=2.469,95%可信区间(95%CI): 1.199~5.188,P=0.047]、ALP<125 U/L(OR=5.499,95%CI: 1.452~18.830,P=0.012)、TBil<22 μmol/L(OR=4.249,95%CI: 1.023~17.648,P=0.046)是影响PEP发生的独立危险因素。结论 即使预防性使用双氯芬酸钠栓剂,术前ALP、TBil水平正常及术中导丝多次进入胰管的患者更易发生PEP,需引起手术医师警惕。根据病情,术前及术后采取早期干预措施可能减少PEHA向PEP进展,减少中重度PEP的发生,改善预后。     

Risk factors for postoperative pancreatitis associated with diagnostic and therapeutic endoscopic retrograde cholangiopancreatography

OBJECTIVE : To investigate the risk factors for postoperative pancreatitis following endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting. METHODS : Four hundred and twelve patients referred to the endoscopy unit were divided into seven groups: (i) double ducts (pancreatic duct and biliary duct) contrast media filling group (ERCP group); (ii) biliary duct contrast media filling group (ERC group); (iii) pancreatic duct contrast media filling group (ERP group); (iv) ERCP plus biliary stenting group (ERCP + stent group); (v) ERC plus stenting group (ERC + stent group); (vi) ERCP plus EST and stone extraction (SE) group (ERCP + EST + SE group); and (vii) ERC plus EST and SE group (ERC + EST + SE group). Differences in postoperative serum amylase at 4 and 24 h, as well as clinical symptoms, were compared among the different groups. RESULTS : The incidence of postoperative hyperamylasemia at 4 and 24 h was 17.7 and 4.4%, respectively. The overall incidence of postoperative acute pancreatitis was 3.9% and the ERP group had the highest incidence of postoperative acute pancreatitis among the seven groups. CONCLUSIONS : Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis and therapeutic ERCP, such as EST, stenting and SE, does not increase the incidence of postoperative pancreatitis.     

生长抑素预防逆行胰胆管造影术后胰腺炎的随机对照

目的：探讨生长抑素预防内镜下逆行胰胆管造影（ERCP）术后胰腺炎和高淀粉酶血症的临床疗效。方法：收集本院行ERCP患者共105例,随机分为3组,各组基础数据如性别、年龄、体重、操作过程（诊断和治疗）等基本相似。预防1组：41例,ERCP术后即开始静滴生理盐水500mL加生长抑素6mg（国产,商品名：丽枝雪）不间断维持24h;预防2组：32例,ERCP术后即开始皮下注射奥曲肽O．1mg（进口,商品名：善宁）每6小时共4次;对照组32例,ERCP术后给予安慰剂（生理盐水）行静脉滴注,但不进行皮下注射。3组均在术前、术后2h、12h及24h检测血清淀粉酶,同时观察腹痛及胰腺炎的发生情况。结果：预防1、2组发生急性胰腺炎分别为17．1％（7／41）、15．6％（5／32）,两组效果相似（P=0．878）,均明显低于对照组40．6％（13／32）,P〈0．027。预防1组ERCP术后血淀粉酶分别是（432．9±342．5）IU／L,（431．6±470．8）IU／L．（321．6±499．8）IU／L,预防2组ERCP术后血淀粉酶分别是（338．7±359．9）IU／L,（560．0±679．5）IU／L,（280．3±341．7）IU／L,均明显低于对照组（377．0±320．2）IU／L,（482．9±497．5）IU／L,（564．4±545．3）IU／L,P〈0．0001。结论：生长抑素对ERCP术后胰腺炎及高淀粉酶血症有预防作用,生长抑素与奥曲肽效果相似。     

Pancreatic pseudocyst associated with eating disorder

We describe a patient with an eating disorder and hyperamylasemia originating from the salivary glands, who developed pancreatitis with a huge pancreatic pseudocyst. A 40-year-old woman was referred for the treatment of an eating disorder that had persisted for 9 years. She was admitted with abdominal pain, diarrhea, and nausea. She had bilateral parotid enlargement with marked elevation of total serum amylase level (3288 IU/l; normal range, 60–220) and an isolated increase of salivary isoamylase activity. After her symptoms resolved, oral intake of food was commenced. She subsequently complained of abdominal pain; this was associated with a slight elevation of serum pancreatic isoamylase and lipase levels, and a huge pancreatic pseudocyst was detected. Percutaneous drainage of the pseudocyst was successful. Endoscopic retrograde cholangiopancreatography demonstrated irregularity of the pancreatic duct. Based on these findings, the final diagnosis was parotid enlargement and acute exacerbation of chronic pancreatitis associated with a pancreatic pseudocyst in a patient with an eating disorder. (Received Dec. 24, 1996; accepted Oct. 30, 1997)     

ERCP术后胰腺炎的诊治分析

目的探讨ERCP术后引起胰腺炎的诊断及防范措施。方法212例拟行ERCP且术前血清淀粉酶正常的患者,随机分为治疗组及对照组。治疗组ERCP术后加用奥曲肽注射液,并检查血清淀粉酶并观察急性胰腺炎发生率。结果术后治疗组6h及24h的血清淀粉酶水平、急性胰腺炎的发生率均低于对照组（P〈0．05）。结论静注奥曲肽可减少ERCP术后胰腺炎及高淀粉酶血症的发生率。     

内镜下鼻胆管引流术对预防治疗性ERCP并发症效果的影响

目的:探讨内镜下鼻胆管引流术对预防治疗性ERCP并发症效果的影响。方法:选择100例ERCP病人,随机分为两组,观察组50例于内镜治疗后行鼻胆管引流,对照组50例内镜治疗后未行鼻胆管引流。结果:观察组ERCP术后高淀粉酶血症发生率明显低于对照组(P<0.05);观察组急性胰腺炎发生率低于对照组(P<0.05)。结论:经内镜鼻胆管引流能够有效地预防ERCP术后急性胰腺炎及高淀粉酶血症的发生。     

小剂量生长抑素预防ERCP术后高淀粉酶血症及胰腺炎的临床研究

目的：探讨生长抑素对内镜逆行胰胆管造影（ＥＲＣＰ）术后患者高淀粉酶血症及化学性胰腺炎的预防作用。方法：１２８例行ＥＲＣＰ患者随机分为两组：预防组６６例患者，分别于ＥＲＣＰ术前及术后各静滴生长抑素２５０μｇ；对照组６２例，仅静脉滴注５％葡萄糖溶液。两组患者分别检查术前及术后４和２４ｈ血淀粉酶水平及观察化学性胰腺炎发生情况。结果：预防组ＥＲ－ＣＰ术后４，２４ｈ血清淀粉酶分别为（２９８±３３）和（１４０±１５６）Ｕ／Ｌ，明显低于对照组的（３８０±３３）和（２４０±２１０）Ｕ／Ｌ（Ｐ＜０．０１）；预防组６６例中发生化学性胰腺炎１例（１．５％），对照组发生３例（４．８％），相差显著（Ｐ＜０．０５）。结论：生长抑素能有效地预防ＥＲＣＰ术后高淀粉酶血症及化学性胰腺炎。     

高淀粉酶血症的临床意义

血淀粉酶升高是临床常见的问题,可由多种病因引起。血清淀粉酶高于正常值上限的3倍,且无明显上腹部疼痛等临床症状,即可诊断为高淀粉酶血症。高淀粉酶血症可见于多种疾病,同工酶分析可提高诊断的特异性,具有较高诊断价值。临床上,应对高淀粉酶血症患者有针对性地开展适当的检查以尽早明确诊断,对症治疗。