Pancreatitis aguda, adenopatías mesentéricas y diarrea

A 34-year-old woman withDown’ssyndromeandadequatemotor,cognitive,andadaptivedevelopmentpresentedtoourhospital’semer-gencyroombecauseofpoorly-defined,continuousse -vereepigastralgiafor24hours,withnoreductionsorexacerbations, radiating to the back, and associatedwithnausea,bilevomiting,andasthenia.Herpersonalhistoryincludednoallergiesortoxichabits,andthepa -tienthadundergonelaparotomyfortheexcisionofaleft ovarian “chocolate cyst” three years before. Thequestioning on organ systems revealed intermittentdyspepticsymptomssinceyoungagewithnomentiontospecifictriggeringfactors,whichconsistedofpost-prandial fullness, heartburn, non-specific epigastricdiscomfort,andflatulence.Shealsoreportedintermit-tent,self-limitedfluiddiarrheaepisodeswithnopatho -logical products, alternating with normal intestinalrhythm.Physicalexplorationrevealedthephenotypicalman -ifestations of trisomy 21; heart and lung auscultationwasnormal;theabdomenwassoftandtendertodeeppalpationintheepigastrium,withnodefensereactionorotherperitonealirritationsigns;palpationrevealednomassesororganomegalies;bowelsoundswerenor-mal.Theremainingexplorationwasuneventful.The CBC and coagulation tests performed in theemergency room were normal, but biochemistry re -vealedelevatedamylaselevels(660IU/l).Thepatientwasadmittedwithadiagnosisofacutepancreatitis.The patient had a favorable clinical course. At 48hoursafteradmissionshewasasymptomatic,toleratedfluidingestion,andlackedRanson’scriteriaforseveri-ty.Duringadmissionthefollowinglabtestswereper-formed: CBC, coagulation, renal and liver function,andlipids,whichwereallnormal.Serumamylasewas624IU/landlipasewas8,859IU/l.Serumironwas43µg/dl,butferritinandtransferrinlevelswerenormal.C-reactiveprotein(CRP)was0.50mg/dl.Twocopro -culturesshowedthestandardsaprophyticbacterialflo -ra,andno