Sargon K, Al-Sabea N, Elango A, Scarbrough B, Wong J, Ebrahim S. Atypical presentation of painless acute pancreatitis: A case report. World J Clin Cases 2025; 13(17): 101008 [DOI: 10.12998/wjcc.v13.i17.101008]
Corresponding Author of This Article
Keon Sargon, MA, MD, Doctor, Department of Internal Medicine, Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60609, United States. kjssargon@gmail.com
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keon Sargon, Nadeem Al-Sabea, Arnold Elango, Brent Scarbrough, Jamesina Wong, Simran Ebrahim, Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL 60609, United States
Co-first authors: Keon Sargon and Nadeem Al-Sabea.
Author contributions: Sargon KJ and Nadeem A reviewed the literature and drafted the manuscript; Sargon KJ reviewed and drafted case summary; Elango A, Scarbrough, Ebrahim S and Wong J were responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the manuscript submission.
Informed consent statement: Informed written consent was obtained from the patient's family for publication of this report and accompanying images.
Conflict-of-interest statement: The authors have no conflict of interest to declare. All co-authors have seen and agree with the contents of the manuscripts and there is no financial interest to report. We certify that the submission is original work and is under review at any other publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Keon Sargon, MA, MD, Doctor, Department of Internal Medicine, Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60609, United States. kjssargon@gmail.com
Received: September 2, 2024 Revised: October 28, 2024 Accepted: January 21, 2025 Published online: June 16, 2025 Processing time: 169 Days and 8.1 Hours
Abstract
BACKGROUND
Painless acute pancreatitis (PAP) is a slowly progressive disease that involves inflammation, scarring, and thickening of pancreatic cells, which can happen due to either alcohol, idiopathic, or genetic. Clinicians usually miss PAP due to lack of pain and additional symptoms of hypotension and fever can lead to an infectious work-up instead. In this case report, we discuss the importance of the rapid discovery of this condition to prevent devastating complications like diabetes, necrotizing pancreatitis, or even death.
CASE SUMMARY
A 47-years old male with past medical history of hypotension and alcohol abuse presented for loss of consciousness. Patient was found with pinpoint pupils, hypoglycemia, and hypotensive. He received Narcan, dextrose, and IV fluids and became responsive. In the emergency department, the patient was hypotensive and the physical exam was only significant for diaphoresis. Patient denied abdominal or radiating pain. Labs significant for elevated lipase, metabolic acidosis, and hyponatremia with imaging positive for AP without chronic inflammation. Based on imaging, lipase and absence of pain, PAP was diagnosed. Patient had multiple episodes of hypoglycemia and remained hypotensive requiring pressor support and intubation. After intubation, he had pulseless electrical activity cardiac arrest. Return of spontaneous circulation achieved but the patient had worsening acidosis, acute kidney injury, liver injury, and bandemia. Empiric antibiotics started, dexamethasone, and maxed on five pressors and transferred to the medical intensive care unit for management of severe AP (SAP).
CONCLUSION
This case report featured PAP without chronic inflammation which is an even rarer disease than PAP which progressed to SAP.
Core Tip: This article highlights an atypical case of painless acute pancreatitis (PAP). This condition is typically a sequela of chronic pancreatitis. However, in this case report, the patient developed PAP in the absence of chronic pancreatitis features or abdominal pain. In addition, this disease course developed into severe acute pancreatitis associated with multiple end-organ damage.
