A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report
Key Clinical Message Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow‐up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed. Abstract It is documented t...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-10-01
|
| Series: | Clinical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ccr3.8037 |
| _version_ | 1797650399108268032 |
|---|---|
| author | Shiva Rahimipour Anaraki Milad Gholizadeh Mesgarha Leyla Bahadorizadeh Morteza Hassanzadeh |
| author_facet | Shiva Rahimipour Anaraki Milad Gholizadeh Mesgarha Leyla Bahadorizadeh Morteza Hassanzadeh |
| author_sort | Shiva Rahimipour Anaraki |
| collection | DOAJ |
| description | Key Clinical Message Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow‐up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed. Abstract It is documented that exocrine pancreatic insufficiency (EPI) can develop after gastrectomy. Steatorrhea, malnutrition, and weight loss are common symptoms of the disease; however, it is usually mild to moderate postgastrectomy. This article reports a case of EPI manifested by hypoalbuminemia leading to dyspnea and anasarca, which are not typical symptoms of postgastrectomy EPI. A 61‐year‐old man with a history of gastric adenocarcinoma treated by total gastrectomy and chemoradiotherapy was admitted to the hospital with dyspnea and anasarca. Despite being diagnosed as a case of malignancy recurrence in another hospital, based on the symptoms described, no evidence of malignancy was found. His ascites and pleural effusion were determined to be caused by hypoalbuminemia. In addition, he claimed steatorrhea, and his stool elastase was lower than expected. EPI was diagnosed based on his medical history, paraclinical tests, and examinations. He remained asymptomatic for 1 year after being treated with albumin and pancreatic enzymes. Postgastrectomy EPI may be severe enough to cause steatorrhea or hypoalbuminemia. Hence, regardless of the severity of the presentation, physicians must be alert for this diagnosis throughout the follow‐up of patients with a history of gastrectomy. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed. |
| first_indexed | 2024-03-11T16:00:48Z |
| format | Article |
| id | doaj.art-355733c0d8b0481eb5e3f8745213c5c2 |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-03-11T16:00:48Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-355733c0d8b0481eb5e3f8745213c5c22023-10-25T07:12:44ZengWileyClinical Case Reports2050-09042023-10-011110n/an/a10.1002/ccr3.8037A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case reportShiva Rahimipour Anaraki0Milad Gholizadeh Mesgarha1Leyla Bahadorizadeh2Morteza Hassanzadeh3Faculty of Medicine Iran University of Medical Sciences (IUMS) Tehran IranFaculty of Medicine Iran University of Medical Sciences (IUMS) Tehran IranAntimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases Iran University of Medical Sciences (IUMS) Tehran IranSchool of Medicine, Department of Internal Medicine Colorectal Research Center, Rasoul‐E‐Akram Hospital, Iran University of Medical Sciences Tehran IranKey Clinical Message Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow‐up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed. Abstract It is documented that exocrine pancreatic insufficiency (EPI) can develop after gastrectomy. Steatorrhea, malnutrition, and weight loss are common symptoms of the disease; however, it is usually mild to moderate postgastrectomy. This article reports a case of EPI manifested by hypoalbuminemia leading to dyspnea and anasarca, which are not typical symptoms of postgastrectomy EPI. A 61‐year‐old man with a history of gastric adenocarcinoma treated by total gastrectomy and chemoradiotherapy was admitted to the hospital with dyspnea and anasarca. Despite being diagnosed as a case of malignancy recurrence in another hospital, based on the symptoms described, no evidence of malignancy was found. His ascites and pleural effusion were determined to be caused by hypoalbuminemia. In addition, he claimed steatorrhea, and his stool elastase was lower than expected. EPI was diagnosed based on his medical history, paraclinical tests, and examinations. He remained asymptomatic for 1 year after being treated with albumin and pancreatic enzymes. Postgastrectomy EPI may be severe enough to cause steatorrhea or hypoalbuminemia. Hence, regardless of the severity of the presentation, physicians must be alert for this diagnosis throughout the follow‐up of patients with a history of gastrectomy. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.https://doi.org/10.1002/ccr3.8037anasarcagastric cancergastrointestinal surgeryhypoalbuminemiapancreatic insufficiencysteatorrhea |
| spellingShingle | Shiva Rahimipour Anaraki Milad Gholizadeh Mesgarha Leyla Bahadorizadeh Morteza Hassanzadeh A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report Clinical Case Reports anasarca gastric cancer gastrointestinal surgery hypoalbuminemia pancreatic insufficiency steatorrhea |
| title | A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report |
| title_full | A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report |
| title_fullStr | A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report |
| title_full_unstemmed | A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report |
| title_short | A life‐threatening presentation of postgastrectomy exocrine pancreatic insufficiency: A case report |
| title_sort | life threatening presentation of postgastrectomy exocrine pancreatic insufficiency a case report |
| topic | anasarca gastric cancer gastrointestinal surgery hypoalbuminemia pancreatic insufficiency steatorrhea |
| url | https://doi.org/10.1002/ccr3.8037 |
| work_keys_str_mv | AT shivarahimipouranaraki alifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT miladgholizadehmesgarha alifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT leylabahadorizadeh alifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT mortezahassanzadeh alifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT shivarahimipouranaraki lifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT miladgholizadehmesgarha lifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT leylabahadorizadeh lifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport AT mortezahassanzadeh lifethreateningpresentationofpostgastrectomyexocrinepancreaticinsufficiencyacasereport |