Korean J Gastroenterol.  2017 Oct;70(4):190-197. 10.4166/kjg.2017.70.4.190.

The Etiologic Evaluation of Acute Pancreatitis in a General Hospital of Seoul-Gyeonggi Province in Korea

• Youn GJ
• Chung WC
• Lee JM
• Paik CN
• Oh JH
• Jung SH

• KMID: 2392915
• DOI: http://doi.org/10.4166/kjg.2017.70.4.190

Abstract

BACKGROUND/AIMS
In recent years, the incidence of acute pancreatitis (AP) has been increasing. A better understanding of the etiology is directly linked to more favorable outcomes. Unfortunately, there have been reports suggesting the variation of etiologies of AP across countries. The objective of this study was to determine the etiology of AP in a general hospital of Seoul-Gyeonggi province in Korea during the past decade.
METHODS
We retrospectively reviewed the medical records of consecutive patients with AP who were admitted to St. Paul's Hospital (Seoul, Korea) with an affiliation to the Catholic University of Korea between January 2003 and January 2013.
RESULTS
A total of 1,110 patients were enrolled, totaling 1,833 attacks, and the most frequent cause of AP was alcohol consumption. The recurrence rate of AP was 24.5% (272/1,110), and habitual recurrence rate (more than three times) was 12.6% (140/1,110). The rate of severe AP was 4.9% (90/1,833 attacks). The mortality rate of AP was 2.6% (29/1,110 patients). The frequency of an idiopathic cause of AP was 13.3%. The recurrence rate and mortality rate of idiopathic AP were 16.2% and 5.4%, respectively. In 41.7% (10/24) of cases of idiopathic AP, microlithiasis was suspected.
CONCLUSIONS
Between 2003 and 2013 in Korea, alcohol was the most frequent cause of AP in the general hospital of Seoul-Gyeonggi province of Korea. It appears that alcohol abstinence program may be necessary. Further nationwide studies would be needed to evaluate the etiologies of AP.

Keyword

Pancreatitis; Alcohols; Gallstone

MeSH Terms

Alcohol Abstinence
Alcohol Drinking
Alcohols
Gallstones
Hospitals, General*
Humans
Incidence
Korea*
Medical Records
Mortality
Pancreatitis*
Recurrence
Retrospective Studies
Alcohols

Figure

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  Fig. 1. Etiology of acute pancreatitis in Korea. Alcohol consumption and gallstones are the main etiologic factors of AP. Other etiology of AP includes autoimmune (n=14), drug-induced (n=7), cancer-related (n=15), IPMN (n=8), pancreas divisum (n=5), and hypertriglyceridemia (n=4). AP, acute pancreatitis; IPMN, intraductal papillary mucinous neoplasm.

• 

  Fig. 2. Autoimmune pancreatitis. (A) Pancreatic parenchymal swelling (arrow) and peripancreatic lower density rim like change (arrowhead). (B) Focal low-attenuating mass (arrow) around the celiac axis and adjacent para-aortic space in a patient with retroperitoneal fibrosis.

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  Fig. 3. Unusual cause of acute pancreatitis-APBDU. (A) In MRCP image, fusiform dilatation of extrahepatic duct (arrow) suggestive of choledochal cyst is observed (Todani classification IA). (B). Fluoroscopic image taken during ERCP showing long common channel (arrow), a definitive finding of APBDU. APBDU, anomalous pancreaticobiliary ductal union; MRCP, magnetic resonance cholangiopancreatography; ERCP, endoscopic retrograde cholangiopancreatography.

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  Fig. 4. Unusual cause of acute pancreatitis-pancreatic AVM. (A) Acute intrapancreatic parenchymal bleeding and hematoma formation (arrow) is observed on CT coronal image. (B) In celiac artery angiography, dense stain in the pancreatic head region and early filling of the veins (double arrows) suggests pancreatic AVM. AVM, arteriovenous malformation; CT, computed tomography.

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  Fig. 5. Unusual cause of acute pancreatitis-pancreatic cancer. (A) Fluoroscopic image taken during ERCP shows focal segmental pancreatic duct narrowing (double arrows) in the proximal body area with post-stenotic dilatation. (B) About 3.0 cm sized ill-defined mass (arrow) of the proximal body of pancreas and pancreatic duct dilatation (arrowhead) of the tail is observed in CT axial view. ERCP, endoscopic retrograde cholangiopancreatography; CT, computed tomography.

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  Fig. 6. Unusual cause of acute pancreatitis-non-Hodgkin's lymphoma and lung cancer. (A) Peripancreatic mass invading the adjacent pancreatic body parenchyme (arrow) resulting in pancreatitis in the pancreatic tail (arrowhead) in diffuse large B cell lymphoma patient. (B) Heterogeneous contrast enhancing mass in the pancreatic tail (arrow) with peri-pancreatic infiltrations in lung cancer patient, suggesting pancreatic metastasis.

Reference

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