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A Case Report of Pancreatic Lipomatosis

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N Jeeva, S Arun Kumar, Joga Veera Balaji, Deepa James    30 October 2018

Unit Chief

Assistant Professor

Final Year PG

Second Year PG

Unit III, Dept. of General Medicine

Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry

Address for correspondence

Dr Joga Veera Balaji

Final Year PG

Unit III, Dept. of General Medicine

Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry

E-mail: jogaveerabalaji@gmail.com

Keywords

Exocrine function, malabsorption, nonalcoholic fatty liver disease, pancreatic lipomatosis

In pancreatic lipomatosis, there will be complete replacement of pancreas by fat usually associated with pancreatic insufficiency. It is speculated that nonalcoholic fatty liver disease begets pancreatic lipomatosis. However, in this case, pancreatic lipomatosis was associated with nonalcoholic steatohepatitis in early cirrhosis. Higher incidence of pancreatic lipomatosis had been observed in obese but in our case the patient was thin.

Case Report

A 75-year-old woman presented with the complaints of abdominal pain on and off, bilateral lower limb swelling, generalized fatigue since 15 days. History of loss of appetite was present. Not a known-case of hypertension, diabetes mellitus, tuberculosis, coronary artery disease.

Clinical examination revealed pallor and bilateral pitting pedal edema. Body mass index (BMI): 19.2. Vital signs were within normal limits. Systemic examination revealed no abnormality. Laboratory investigations: Hemoglobin (Hb) - 6 g/dL, peripheral smear showed microcytic hypochromic anemia. Prothrombin time (PT) - 19.1, international normalized ratio (INR) - 2.02, routine blood tests, renal function tests are normal.

Lipid profile - normal. Blood sugar - normal. Echo - within normal limits. USG abdomen - chronic parenchymal liver disease. CT abdomen - diffuse parenchymal liver disease with heterogeneous fatty infiltration. Mild nodular surface with complete fatty replacement of pancreas, few perigastric collaterals and degenerative changes in spine. Liver biopsy - early cirrhosis. Upper gastrointestinal endoscopy - no abnormality. Serum amylase and lipase - normal.

Discussion

Incidence of pancreatic lipomatosis is unknown. Several predisposing factors have been suggested. These include age, obesity, diabetes mellitus, chronic pancreatitis, hereditary pancreatitis, pancreatic duct obstruction by calculus or tumor and cystic fibrosis. In normal individuals, only 10% of parenchyma is sufficient for maintenance of normal exocrine function.

Even though the total parenchyma of pancreas was replaced by fat in our patient, she had no exocrine and endocrine deficiency symptoms.

The subtypes are even pancreatic lipomatosis and uneven pancreatic lipomatosis. Uneven pancreatic lipomatosis may present as:

Type 1a: Preferential fatty replacement of head.

Type 1b: Preferential fatty replacement of head, neck and body.

Type 2a: Preferential fatty replacement of head and uncinate process.

Type 2b: Fatty replacement of most of pancreas except peribiliary region.

The role of ultrasound in the diagnosis of pancreatic lipomatosis is very limited. However, the CT has an important role in evaluation of pancreatic disease.

Suggested Reading

  1. Reddy OJ, Gafoor JA, Reddy GM, Prasad PO. Total pancreatic lipomatosis: A rare presentation. J NTR Univ Health Sci. 2015;4(4):272-4.
  2. Anand R, Narula MK, Chaudhary V, Agrawal R. Total pancreatic lipomatosis with malabsorption syndrome. Indian J Endocrinol Metab. 2011;15(1): 51-3.
  3. Prachayakul V, Aswakul P. Pancreatic steatosis: what should gastroenterologists know? JOP. J Pancreas (Online). 2015;16(3):227-31.

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