Skip to main content

Advertisement

SpringerLink
Log in

Two rare pancreatic parenchymal hemorrhagic lesions associated with acute pancreatitis in acute liver failure: a case report and literature review

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Acute pancreatitis is an uncommon occurrence in acute liver failure. Furthermore, such cases are rarely complicated by parenchymal hemorrhages. Herein, we report the case of a 69-year-old male patient with multiple pancreatic parenchymal hemorrhages concomitant with acute liver failure. The patient underwent conservative treatment for acute liver failure caused by hepatitis B virus infection. Plain computed tomography on the 30th day revealed two high-density mass lesions in the pancreatic body and tail, which were suspected to be multiple pancreatic parenchymal hemorrhages. Despite restarting gabexate mesylate, the patient died of multiple organ failure on the 49th day. The clinical information of the present case and our literature review of 61 similar cases in 43 case reports identified via a systematic keyword search of the PubMed database, which described acute pancreatitis concomitant with acute hepatitis and acute liver failure, will aid physicians in the diagnosis and treatment of this rare condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. Kirino I, Fujimoto Y, Hata K, et al. Liver transplantation for acute liver failure accompanied by severe acute pancreatitis. BMJ Case Rep. 2016. https://doi.org/10.1136/bcr-2016-215959.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yan L, Qian C, Duan X, et al. Poor prognosis of liver transplantation for acute liver failure with acute pancreatitis: two case reports. Medicine. 2020;99: e22934.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Somani SK, Ghosh A, Awasthi G. Severe acute pancreatitis with pseudocyst bleeding due to hepatitis E virus infection. Clin J Gastroenterol. 2009;2:39–42.

    Article  PubMed  Google Scholar 

  4. Medows M, Acosta C, Vega V. Pancreatitis and acute liver failure from Coricidin® HBP intoxication. Cureus. 2020;12: e10202.

    PubMed  PubMed Central  Google Scholar 

  5. Lochan R, Charnley RM, French JJ, et al. Successful management of necrotizing pancreatitis by percutaneous necrosectomy after orthotopic liver transplant for paracetamol induced acute liver failure: a case report. Exp Clin Transplant. 2009;7:110–4.

    PubMed  Google Scholar 

  6. Gove CD, Wardle EN, Williams R. Circulating lysosomal enzymes and acute hepatic necrosis. J Clin Pathol. 1981;34:13–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bernal Monterde V, Campillo Arregui A, Sostres Homedes C, et al. Acute necrotizing pancreatitis and severe hepatic failure: description of three cases. Transplant Proc. 2008;40:3117–20.

    Article  CAS  PubMed  Google Scholar 

  8. Shimoda T, Shikata T, Karasawa T, et al. Light microscopic localization of hepatitis B virus antigens in the human pancreas. Possibility of multiplication of hepatitis B virus in the human pancreas. Gastroenterology. 1981;81:998–1005.

    Article  CAS  PubMed  Google Scholar 

  9. Panic N, Mihajlovic S, Vujasinovic M, et al. Pancreatitis associated with viral hepatitis: systematic review. J Clin Med. 2020;9:3309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Wands JR, Salyer DC, Boitnott JK, et al. Fulminant hepatitis complicated by pancreatitis. Johns Hopkins Med J. 1973;133:156–60.

    CAS  PubMed  Google Scholar 

  11. Cavallari A, Vivarelli M, D’Errico A, et al. Acute necrotizing pancreatitis due to hepatitis B virus reinfection in a liver transplant recipient. Transplant Proc. 1994;26:3649–50.

    CAS  PubMed  Google Scholar 

  12. Bhagat S, Wadhawan M, Sud R, et al. Hepatitis viruses causing pancreatitis and hepatitis: a case series and review of literature. Pancreas. 2008;36:424–7.

    Article  PubMed  Google Scholar 

  13. Chou SC, Shyr YM, Wang SE. Pancreatic arteriovenous malformation. J Gastrointestinal Surg. 2013;17:1240–6.

    Article  Google Scholar 

  14. Meyer A, Behrend M. Is pancreatic resection justified for metastasis of papillary thyroid cancer? Anticancer Res. 2006;26:2269–73.

    CAS  PubMed  Google Scholar 

  15. Sagar S, Soundarajan R, Gupta P, et al. Efficacy of endovascular embolization of arterial pseudoaneurysms in pancreatitis: a systematic review and meta-analysis. Pancreatology. 2021;21:46–58.

    Article  PubMed  Google Scholar 

  16. Ham JM, Fitzpatrick P. Acute pancreatitis in patients with acute hepatic failure. Am J Dig Dis. 1973;18:1079–83.

    Article  CAS  PubMed  Google Scholar 

  17. Flati G, Andrén-Sandberg A, La Pinta M, et al. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas. 2003;26:8–14.

    Article  PubMed  Google Scholar 

  18. Navasa M, Garcia-Pagán JC, Bosch J, et al. Portal hypertension in acute liver failure. Gut. 1992;33:965–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Imamura Y, Kumagi T, Kuroda T, et al. Pancreas stiffness in liver cirrhosis is an indicator of insulin secretion caused by portal hypertension and pancreatic congestion. Hepatol Res. 2021;51:775–85.

    Article  CAS  PubMed  Google Scholar 

  20. Sharma PK, Madan K, Garg PK. Hemorrhage in acute pancreatitis: should gastrointestinal bleeding be considered an organ failure? Pancreas. 2008;36:141–5.

    Article  PubMed  Google Scholar 

  21. Polson J, Lee WM. American Association for the Study of Liver Disease. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41:1179–97.

    Article  PubMed  Google Scholar 

  22. Lopez Morante A, de Rodriguez Lope C, San Miguel G, et al. Acute pancreatitis in hepatitis A infection. Postgrad Med J. 1986;62:407–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Eugene C, Cadranel JF, Bergue A, et al. Acute pancreatitis associated with non-A-non-B hepatitis. Report of a case. J Clin Gastroenterol. 1990;12:195–7.

    Article  CAS  PubMed  Google Scholar 

  24. Garty BZ, Kanner D, Danon YL. Pancreatitis associated with hepatitis A viral infection. J Pediatr. 1995;127:669.

    Article  CAS  PubMed  Google Scholar 

  25. Shrier LA, Karpen SJ, McEvoy C. Acute pancreatitis associated with acute hepatitis A in a young child. J Pediatr. 1995;126:57–9.

    Article  CAS  PubMed  Google Scholar 

  26. Amarapurkar DN, Begani MM, Mirchandani K. Acute pancreatitis in hepatitis A infection. Trop Gastroenterol. 1996;17:30–1.

    CAS  PubMed  Google Scholar 

  27. de Oliveira LC, Rezende PB, Ferreira AL, et al. Concurrent acute hepatitis and pancreatitis associated with hepatitis B virus: case report. Pancreas. 1998;16:559–61.

    Article  PubMed  Google Scholar 

  28. Agarwal KS, Puliyel JM, Mathew A, et al. Acute pancreatitis with cholestatic hepatitis: an unusual manifestation of hepatitis A. Ann Trop Paediatr. 1999;19:391–4.

    Article  CAS  PubMed  Google Scholar 

  29. Sood A, Midha V. Hepatitis A and acute pancreatitis. J Assoc Physicians India. 1999;47:736–7.

    CAS  PubMed  Google Scholar 

  30. Majumder AK, Halder A, Talapatra DS, et al. Hepatitis E associated with acute pancreatitis with pseudocyst. J Assoc Physicians India. 1999;47:1207–8.

    CAS  PubMed  Google Scholar 

  31. Mishra A, Saigal S, Gupta R, et al. Acute pancreatitis associated with viral hepatitis: a report of six cases with review of literature. Am J Gastroenterol. 1999;94:2292–5.

    Article  CAS  PubMed  Google Scholar 

  32. Alvares-Da-Silva MR, Francisconi CF, Waechter FL. Acute hepatitis C complicated by pancreatitis: another extrahepatic manifestation of hepatitis C virus? J Viral Hepat. 2000;7:84–6.

    Article  CAS  PubMed  Google Scholar 

  33. Maity SG, Ray G. Severe acute pancreatitis in acute hepatitis E. Indian J Gastroenterol. 2002;21:37–8.

    PubMed  Google Scholar 

  34. Batra Y, Chakravarty S, Bhatt G. Severe acute pancreatitis associated with acute hepatitis A: a case report. Trop Gastroenterol. 2003;24:27–8.

    PubMed  Google Scholar 

  35. Khanna S, Vij JC. Severe acute pancreatitis due to hepatitis A virus infection in a patient of acute viral hepatitis. Trop Gastroenterol. 2003;24:25–6.

    CAS  PubMed  Google Scholar 

  36. Ohshiro Y, Tawata M, Takasu N. Acute pancreatitis and exacerbation of hepatitis B following reduced dose of prednisolone. QJM. 2003;96:868–9.

    Article  CAS  PubMed  Google Scholar 

  37. Makharia GK, Garg PK, Tandon RK. Acute pancreatitis associated with acute hepatitis E infection. Trop Gastroenterol. 2003;24:200–1.

    PubMed  Google Scholar 

  38. Srinivasan A, Venkataraman S, Hansdak SG, et al. Hyperglycaemia as an indicator of concurrent acute pancreatitis in fulminant hepatic failure associated with hepatitis B infection. Singapore Med J. 2005;46:236–7.

    CAS  PubMed  Google Scholar 

  39. Jaroszewicz J, Flisiak R, Kalinowska A, et al. Acute hepatitis E complicated by acute pancreatitis: a case report and literature review. Pancreas. 2005;30:382–4.

    Article  PubMed  Google Scholar 

  40. Ertekin V, Selimoglu MA, Konak M, et al. Association of hepatitis a and acute pancreatitis presenting as acute abdomen. Pancreas. 2005;31:298–9.

    Article  PubMed  Google Scholar 

  41. Basaranoglu M, Balci NC, Klör HU. Gallbladder sludge and acute pancreatitis induced by acute hepatitis A. Pancreatology. 2006;6:141–4.

    Article  PubMed  Google Scholar 

  42. Jain P, Nijhawan S, Rai RR, et al. Acute pancreatitis in acute viral hepatitis. World J Gastroenterol. 2007;13:5741–4.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Moleta DB, Kakitani FT, Lima AS, et al. Acute pancreatitis associated with acute viral hepatitis: case report and review of literature. Rev Inst Med Trop Sao Paulo. 2009;51:349–51.

    Article  PubMed  Google Scholar 

  44. Yoo KS, Lee KH, Huh KR, et al. Acute pancreatitis complicating spontaneous acute exacerbation of chronic hepatitis B virus infection: case report and review of the literature. Gut Liver. 2009;3:64–6.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Thapa R, Biswas B, Mallick D, et al. Acute pancreatitis–complicating hepatitis E virus infection in a 7-year-old boy with glucose 6 phosphate dehydrogenase deficiency. Clin Pediatr. 2009;48:199–201.

    Article  Google Scholar 

  46. Mottram AR, Lazio MP, Bryant SM. Lepiota subincarnata JE Lange induced fulminant hepatic failure presenting with pancreatitis. J Med Toxicol. 2010;6:155–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Deniel C, Coton T, Brardjanian S, et al. Acute pancreatitis: a rare complication of acute hepatitis E. J Clin Virol. 2011;51:202–4.

    Article  PubMed  Google Scholar 

  48. El-Sayed R, El-Karaksy H. Acute pancreatitis complicating acute hepatitis A virus infection. Arab J Gastroenterol. 2012;13:184–5.

    Article  PubMed  Google Scholar 

  49. Kang SJ, Yoon KH, Hwang JB. Epstein-barr virus infection with acute pancreatitis associated with cholestatic hepatitis. Pediatr Gastroenterol Hepatol Nutr. 2013;16:61–4.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Nayak HK, Kamble NL, Raizada N, et al. Acute pancreatitis complicating acute hepatitis e virus infection: a case report and review. Case Reports Hepatol. 2013;2013: 531235.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Karanth SS, Khan Z, Rau NR, et al. Acute hepatitis E complicated by acute pancreatitis and multiorgan dysfunction. BMJ Case Rep. 2014. https://doi.org/10.1136/bcr-2014-203875.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Thakur A, Basu PP. Acute non-fulminant viral hepatitis E presenting with acute pancreatitis-an unusual presentation. Malays J Med Sci. 2017;24:102–5.

    PubMed  PubMed Central  Google Scholar 

  53. Albert AR, Valencia R, Smereck JA. Acute hepatitis B with pancreatitis and cholecystitis leading to acute liver failure and death. Clin Pract Cases Emerg Med. 2018;2:304–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Adhikari S, Shrestha AL, Thapa SR, et al. A rare cause of acute hepatopancreatitis in a Nepalese teen. Case Rep Pediatr. 2018;2018:8456503.

    PubMed  PubMed Central  Google Scholar 

  55. Lingareddy HR, Nair HR, Varghese J, et al. Acute pancreatitis complicating liver transplantation in a case of fulminant hepatic failure due to yellow phosphorus poisoning. J Clin Exp Hepatol. 2021;11:154–6.

    Article  CAS  PubMed  Google Scholar 

  56. Debnath P, Datta AK, Chakraborty U, et al. Acute viral hepatitis E complicated with acute pancreatitis in an immunocompetent adult. BMJ Case Rep. 2021;14: e239684.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Seta T, Noguchi Y, Shikata S, et al. Treatment of acute pancreatitis with protease inhibitors administered through intravenous infusion: an updated systematic review and meta-analysis. BMC Gastroenterol. 2014;14:102.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Zhang J, Niu L, Yang Y, et al. Systematic review and meta-analysis of the efficacy of trypsin inhibitors in patients with severe pancreatitis. Ann Palliat Med. 2021;10:6577–87.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Editage for the critical reading of the manuscript and English language editing.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1–757 Asahimachi–dori, Chuo–ku, Niigata, 9518510, Japan

    Ryo Jimbo, Yoshihisa Arao, Atsunori Tsuchiya, Hanako Yamazaki, Masaki Mito, Yuichi Kojima, Naruhiro Kimura, Kazunao Hayashi & Shuji Terai

  2. Division of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka, Japan

    Ryo Jimbo & Yuji Kobayashi

Authors
  1. Ryo Jimbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihisa Arao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atsunori Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hanako Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaki Mito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuichi Kojima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naruhiro Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazunao Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shuji Terai
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RJ: wrote the manuscript; YA: made manuscript revisions; AT: supervised the writing of the manuscript; HY, MM, YK, YK, NK, and KH: treated the patient; ST: supervised the writing of the manuscript; all authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Yoshihisa Arao.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jimbo, R., Arao, Y., Tsuchiya, A. et al. Two rare pancreatic parenchymal hemorrhagic lesions associated with acute pancreatitis in acute liver failure: a case report and literature review. Clin J Gastroenterol 16, 254–262 (2023). https://doi.org/10.1007/s12328-022-01738-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-022-01738-x

Keywords

Search

Navigation