Acute Pancreatitis with Hemorrhagic Pseudocyst in a Heart-Transplant Patient

• Published in: The Journal of heart and lung transplantation Vol. 40; no. 4; p. S475
• Main Authors: Mahgoub, M., Bakhsh, A., Alanazi, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2021
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2021.01.1315

In the last 3 decades heart transplantation has been dramatically evolving leading to successful results. Nevertheless, complications have been always on the side parallel to it. Although acute pancreatitis was one of the listed serious complications that was well reported, still the causes and best way of management is not clear yet. A 40-year-old woman was admitted to the hospital two weeks post heart transplant with abdominal pain. She is known to have dilated cardiomyopathy who underwent heart transplant with uneventful post-operative course. Her immunosuppressive regimen included prednisolone, mycophenolate mofetil and tacrolimus .she was complaining of epigastric pain radiating to the back. Her Labs showed amylase of 144 . The CT abdomen showed Evidence of large loculated Pseudo-pancreatic (image A), which has suggested late presentation of pancreatitis with no evidence of biliary pancreatitis. She was started on hydration, analgesia, and empirical antibiotic. A repeated CT showed progression of pseudocyst and formation of smaller cysts. Furthermore, she had a drop of hemoglobin Hb from 8 to 5. Urgent CT angiogram showed a bleeding splenic artery into the peripancreatic cyst (image B). Embolization of the proximal splenic artery was done by IR. We opted for conservative management . It was though that any trial for draining the cyst may lead to infection. As may be a cause of this event, tacrolimus was substituted with cyclosporine . A repeated abdominal CT scan showed improvement and no changes in the pseudocyst. She was kept on Conservative management aiming for repeating the CT scan within 6 weeks The proper timing for diagnosing acute pancreatitis remains difficult due to the obscure symptoms and signs that patient with post-transplant may show. It needs always high index of clinical suspicion to avoid the catastrophic sequalae .In addition, dealing with complications itself remains controversial in terms of the appropriate modality of treatment for such immunocompromised patient .