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CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2021; 11(03): 207-208
DOI: 10.1055/s-0041-1726691
Case Report

Recurrent Acute Pancreatitis following Colonoscopic Fecal Microbiota Transplantation for Ulcerative Colitis

Avnish Kumar Seth
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Mahesh Kumar Gupta
1   Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Radha Krishan Verma
2   Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Abstract

A 37-year-old man with corticosteroid-dependent ulcerative pancolitis was taken up for colonoscopic fecal microbiota transplant (FMT). Preparation for colonoscopy was done with 118 g polyethylene glycol (PEG) in 2 L water ingested over 2 hours, followed by clear fluids. 200 g of screened donor stool, blended with water was instilled into terminal ileum; cecum; and ascending, transverse, and descending colon. Eighteen hours following ingestion of PEG and 2 hours following FMT, he complained of severe epigastric pain with radiation to back. Serum lipase was 6,756 U/L. He was managed with intravenous (IV) fluids and symptomatic treatment with discontinuation of corticosteroids and 6-MP. Ultrasound did not reveal gall bladder stones or sludge. There was no history of alcohol intake. Contrast-enhanced computed tomography scan at 48 hours showed bulky pancreas with peripancreatic stranding. He recovered over a week with normalization of lipase. Three weeks later he again reported severe epigastric pain 14 hours following ingestion of PEG, this time prior to colonoscopic FMT. Serum lipase was 1,140 U/L; the procedure was deferred and he recovered with symptomatic treatment over 3 days. Maintenance colonoscopic FMT was performed 4 times over the following 2 years with sodium phosphate preparation with no recurrence of pain. MRCP showed no evidence of chronic pancreatitis. He remains in clinical and endoscopic steroid-free, thiopurine-free remission. PEG is a rare cause of acute pancreatitis and merits consideration in appropriate clinical setting.

Keywords

fecal microbiota transplantation - acute pancreatitis - polyethylene glycol


Publication History

Article published online:
11 May 2021

© 2021. Nitte (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Lam WC, Zhao C, Ma WJ. Yao L. The clinical and steroid-free remission of fecal microbiota transplantation to patients with ulcerative colitis: a meta-analysis. Gastroenterol Res Pract 2019; 2019: 1287493
    PubMedGoogle Scholar
  • 2 Bermejo F, Lopez-Sanroman A, Taxonera C. et al. Acute pancreatitis in inflammatory bowel disease, with special reference to azathioprine-induced pancreatitis. Aliment Pharmacol Ther 2008; 28 (05) 623-628
    CrossrefPubMedGoogle Scholar
  • 3 Rasmussen HH, Fonager K, Sørensen HT, Pedersen L, Dahlerup JF, Steffensen FH. Risk of acute pancreatitis in patients with chronic inflammatory bowel disease. A Danish 16-year nationwide follow-up study. Scand J Gastroenterol 1999; 34 (02) 199-201
    CrossrefPubMedGoogle Scholar
  • 4 Franga DL, Harris JA. Polyethylene glycol-induced pancreatitis. Gastrointest Endosc 2000; 52 (06) 789-791
    CrossrefPubMedGoogle Scholar
  • 5 Limb C, Ibrahim IAK, Fitzsimmons S, Harper AJ. Recurrent pancreatitis after unremarkable colonoscopy, temporalised by CT imaging: an unusual case. BMJ Case Rep 2016; 2016: bcr2015213192
    CrossrefPubMedGoogle Scholar