A Von Hippel-Lindau Masked by an Acute Pancreatitis

Case Report

Austin J Emergency & Crit Care Med. 2014;1(2): 2.

A Von Hippel-Lindau Masked by an Acute Pancreatitis

Ceruti S1*, De Vivo S2, Peruzzo M2 and Andreas Cerny3

1Department of Intensive Care Medicine, Ospedale Regionale di Bellinzona, Switzerland

2Department of Anesthesiology, Ospedale Regionale di Bellinzona, Switzerland

3Department of Internal Medicine, Clinica Luganese, Switzerland

*Corresponding author: Samuele Ceruti, Department of Intensive Care Medicine, Ospedale Regionale di Bellinzona, Via Ospedale 12, 6500, Bellinzona, Switzerland

Received: September 27, 2014; Accepted: November 14, 2014; Published: November 18, 2014

We describe the case-report of a 45 years-old man suffering from chronic pancreatic disease with strong acute mesogastric pain, nausea and vomiting result of acute abdomen suspicious for acute pancreatitis. A thorough diagnostic investigation led us to diagnose a rare disease.

A 45 years-old man was admitted to the Emergency Department for exacerbation of chronic mesogastric pain, started approximately one year before and actually worsened. An abdominal MRI revealed a pancreas with a lot of several cystic lesions with a maximum diameter of 2.5 mm (Figures 1-3). On clinical examination the arterial pressure was 140/80 mmHg at both arms, arterial pulse 85 beats per minute; the weight around 80 Kg. The abdomen was soft, with strong pain on palpation in the mesogastric region without irradiation; instead the rest of the clinical examination was normal. The haematocrit level was 41% (reference range, 41.0 to 53.0 in men), the platelet count 356,000 per cubic millimeter (reference range, 150,000 to 400,000), the lipase level 2.1 U/dL (reference range, 1.3 to 6.0), and the amylase level 57 U/L (reference range, 3 to 100), mild hyperglycaemia (6.5 mmol/L), hypercholesterolemia (total cholesterol 5.3 mmol/L, LDL cholesterol 3.9 mmol/L), increased levels of ALAT (58 U/L) and mild hypocalcaemia (2.17 mmol/L). Others laboratory-test results (including the white-cell count and the differential count, serum levels of electrolytes, total protein, albumin, globulin, bilirubin, creatine kinase, creatine kinase isoenzymes and troponin I and tests of coagulation and renal function) were normal. A previous Esophago-Gastro-Duodenal Scopy (EGDS) showed pangastritis with large amount of bile.