Abstract
Abstract Hypertriglyceridemia (HTG) is one of the major causes of acute pancreatitis. When HTG is recognized, it thought that immediately lowering the triglyceride (TG) levels in the blood during treatment can improve the symptoms of pancreatitis. In this study, we experienced a case of severe acute pancreatitis accompanying HTG. A 30-year-old male presented with abdominal pain. The TG level at admission was 2,150mg/dL, and abdominal dynamic CT revealed severe acute pancreatitis. Fluid replacement/continuous regional arterial infusion (CRAI) was administered to treat the pancreatitis in addition to LDL (low-density lipoprotein) apheresis for the HTG. After the first cycle of LDL apheresis, the TG level declined to 974mg/dL; however, the patient's abdominal pain did not improve. Six hours later, we performed the second cycle of LDL apheresis, and the TG level subsequently declined to 317mg/dL, with improvements in abdominal symptoms. CRAI was terminated on the fourth hospital day, and the patient was discharged on the 16th hospital day. Acute pancreatitis accompanying HTG is thought to be caused by lipids interfering with pancreas microcirculation. As a result, CRAI may not show a sufficient effect under conditions of HTG. LDL apheresis may be safely carried out without any major side effects and with an immediate decline in TG. We therefore consider that LDL apheresis, used in combination with CRAI, may improve the symptoms of severe acute pancreatitis accompanying HTG.
