All baseline laboratory tests as well as blood and urine cultures were taken. Immediate intravenous access was obtained. Rest of the systemic examinations were not significant. There was no guarding, no rigidity or rebound tenderness. The patient also had diffuse abdominal tenderness, more at epigastrium, but with no distension. On physical examination, he had a toxic appearance with scleral icterus. In ED, his pulse rate was 120/minute and low volume, blood pressure was 90/60 mmHg, respiratory rate of 24/minute, oxygen saturation of 98% in room air, and temperature of 97.8☏. He described the pain as sharp, diffuse, and more severe in the epigastrium, which worsened with movement and did not relieve by oral analgesics. He had no history of alcohol consumption. He had a history of multiple past hospitalizations for vaso-occlusive crises. We present a case of acute pancreatitis as a rare manifestation of vaso-occlusive painful crisis in a patient with SCD, presumably due to microvessel occlusion and ischemic injury to the pancreas.Ī 20-year-old male patient with a history of heterozygous SCD (Hb SS)-beta thalassemia since 2008 presented to the emergency department (ED) with diffuse abdominal pain and back pain for 7 days, which worsened over last 2 days. Pancreatic ischemia is an uncommon but established cause of pancreatitis associated with connective tissue diseases, vasculitis, and shock ( 6 ). Gallstones and alcohol abuse are the major causes of acute pancreatitis ( 5 ). Acute pancreatitis has been described as a very rare manifestation of vaso-occlusive painful crisis ( 3, 4 ). Virtually all organs in the body are affected by vaso-occlusion. The deformed RBCs cause vaso-occlusion, tissue ischemia, and infarction. Deoxygenated HbS causes distortion of red blood cells (RBCs) when the oxygen saturation is lowered in conditions such as stress, infection, or dehydration. It is characterized by chronic hemolytic anemia and repeated episodes of vaso-occlusive painful crisis ( 1, 2 ). Sickle cell disease (SCD) is an autosomal recessive disease and one of the most common hemoglobinopathies, accompanied with production of hemoglobin S (Hb S) due to a point mutation in the beta globin gene.
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