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      Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis

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          Abstract

          Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

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          Issues in Hyperlipidemic Pancreatitis

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            Issues in hyperlipidemic pancreatitis.

            Hypertriglyceridemia (HTG) is a rare cause of pancreatitis. Pancreatitis secondary to HTG, presents typically as an episode of acute pancreatitis (AP) or recurrent AP, rarely as chronic pancreatitis. A serum triglyceride (TG) level of more than 1,000 to 2,000 mg/dL in patients with type I, IV, or V hyperlipidemia (Fredrickson's classification) is an identifiable risk factor. The typical clinical profile of hyperlipidemic pancreatitis (HLP) is a patient with a preexisting lipid abnormality along with the presence of a secondary factor (e.g., poorly controlled diabetes, alcohol use, or a medication) that can induce HTG. Less commonly, a patient with isolated hyperlipidemia (type V or I) without a precipitating factor presents with pancreatitis. Interestingly, serum pancreatic enzymes may be normal or only minimally elevated, even in the presence of severe pancreatitis diagnosed by imaging studies. The clinical course in HLP is not different from that of pancreatitis of other causes. Routine management of AP caused by hyperlipidemia should be similar to that of other causes. A thorough family history of lipid abnormalities should be obtained, and an attempt to identify secondary causes should be made. Reduction of TG levels to well below 1,000 mg/dL effectively prevents further episodes of pancreatitis. The mainstay of treatment includes dietary restriction of fat and lipid-lowering medications (mainly fibric acid derivatives). Experiences with plasmapheresis, lipid pheresis, and extracorporeal lipid elimination are limited.
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              Evaluating interference caused by lipemia.

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                Author and article information

                Journal
                Case Rep Pediatr
                Case Rep Pediatr
                CRIPE
                Case Reports in Pediatrics
                Hindawi Publishing Corporation
                2090-6803
                2090-6811
                2016
                27 January 2016
                : 2016
                : 9123163
                Affiliations
                1Department of Pediatrics, Section of Pediatric Gastroenterology, University of Chicago, Wyler Pavilion C-474, 5839 S. Maryland Avenue, MC 4065, Chicago, IL 60637, USA
                2Department of Pediatrics, Section of Pediatric Surgery, The University of Chicago Hospitals, 5841 S. Maryland Avenue, MC 4062, Chicago, IL 60637, USA
                Author notes

                Academic Editor: Daniel K. L. Cheuk

                Article
                10.1155/2016/9123163
                4748093
                26925282
                66ece984-0ebb-4b5b-92c1-3d9299720372
                Copyright © 2016 Tiffany J. Patton et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 August 2015
                : 17 December 2015
                : 30 December 2015
                Categories
                Case Report

                Pediatrics
                Pediatrics

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