Acute Pancreatitis Complicated by Subacute Intestinal Obstruction and Acute Chest Syndrome in a Patient with Sickle Cell Disease: A Case Report.

Abstract

Background

Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with chronic haemolysis, vasoocclusion, endothelial dysfunction, and multiorgan complications. Acute abdominal pain in SCD is diagnostically challenging because vaso-occlusive crisis may mimic pancreatitis, bowel obstruction, mesenteric ischemia, or hepatobiliary disease. Acute pancreatitis and intestinal obstruction are uncommon complications, while acute chest syndrome (ACS) remains a major cause of morbidity and mortality. Their simultaneous occurrence during a single admission is rare and requires prompt multidisciplinary recognition and management.

Case Report

A  26-year-old male with known SCD and beta-thalassemia trait presented with acute abdominal pain associated with vomiting, loose stools and fever. The abdominal pain was preceded by alcohol intake. Examination revealed abdominal tenderness and sluggish bowel sounds. Laboratory investigations showed anemia, leukocytosis, thrombocytopenia, deranged liver function tests and markedly elevated serum amylase and lipase. Erect abdominal radiography showed multiple air-fluid levels suggestive of subacute intestinal obstruction or ileus Contrast-enhanced computed tomography revealed autosplenectomy, mildly dilated bowel loops without definite mechanical obstruction. He was managed conservatively with bowel rest surgical monitoring and supportive care. He subsequently developed signs consistent with ACS. Intensive care management included oxygen supplementation, blood transfusion, broad-spectrum antibiotics and supportive management. With appropriate intensive case his haemodynamic parameters improved and he was discharged in stable condition.

Conclusion

Persistent abdominal pain in SCD should not be solely attributed to vaso-occlusive crisis. Early abdominal imaging, pancreatic enzyme estimation, respiratory assessment and multidisciplinary conservative management is essential for detecting overlapping pancreatitis, functional intestinal obstruction and ACS in cases of SCD.