Pancreatitis necrotizante por organofosforados: de la sospecha clínica al tratamiento oportuno - reporte de un caso

[Organophosphate necrotizing pancreatitis: from clinical suspicion to timely treatment - case report]
DOI: 10.37980/im.journal.rmdp.20221850
Publicado
2022-05-16

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Autores/as

  • Abdullah Salehji Bhana Complejo Hospitalario Doctor Arnulfo Arias Madrid. Panamá.

Palabras clave:

pancreatitis, organofosforados, intoxicación

Keywords:

pancreatitis, organophosphate, intoxication

Resumen

Introducción: La intoxicación con organofosforados se ha descrito como causa poco frecuente de pancreatitis aguda. En la literatura, son escasos los reportes de casos de esta asociación y el mecanismo fisiopatológico que lleva al desarrollo de necrosis en esta situación, está aún menos estudiada. Por esta razón presentamos este caso de esta inusual asociación.

Presentación de caso: masculino de 45 años que es llevado por familiares a hospital de segundo nivel por cuadro clínico compatible con intoxicación por organofosforados. Desde el ingreso con niveles elevados de amilasa y ultrasonido abdominal sin datos sugestivos de pancreatitis, sin embargo, con dolor abdominal típico que mejora progresivamente con el manejo conservador instaurado. A pesar de esto, inicia con datos de disfunción pancreática y en la tomografía computarizada se reporta necrosis de >90% de la estructura pancreática, compatible con pancreatitis aguda necrótica. Al no haber datos de infección sistémica, se ofrece manejo conservador con adecuada respuesta.

Conclusión: la pancreatitis es una complicación que debe ser buscada en pacientes con intoxicación por organofosforados, ya que el tratamiento oportuno mejora significativamente el pronóstico.


Abstract

Introduction: Organophosphate poisoning has been described as a rare cause of acute pancreatitis. In the literature, case reports of this association are scarce and the pathophysiological mechanism that leads to the development of necrosis in this situation is even less studied. For this reason, we present this case of this unusual association.

Case presentation: 45-year-old male who was taken by family members to a second level hospital with clinical symptoms compatible with organophosphate poisoning. Since admission, he had elevated amylase levels and abdominal ultrasound with no data suggestive of pancreatitis, however, with typical abdominal pain that improved progressively with conservative management. Despite this, he started with data of pancreatic dysfunction and the CT scan showed necrosis of >90% of the pancreatic structure, compatible with acute necrotic pancreatitis. Since there was no evidence of systemic infection, conservative management was offered with adequate response.

Conclusion: pancreatitis is a complication that should be sought in patients with organophosphate poisoning since timely treatment significantly improves prognosis.

Citas

Ringman JM, Cummings JL. Metrifonate (Trichlorfon): a review of the pharmacology, pharmacokinetics, and clinical experience with a new acetylcholinesterase inhibitor for Alzheimer's disease. Expert Opin Investig Drugs. 1999 Apr;8(4):463-71. doi: 10.1517/13543784.8.4.463.

López-Arrieta JM, Schneider L. Metrifonate for Alzheimer's disease. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003155. doi: 10.1002/14651858.CD003155.pub3. PMID: 16625573.

King AM, Aaron CK. Organophosphate and carbamate poisoning. Emerg Med Clin North Am. 2015 Feb;33(1):133-51. doi: 10.1016/j.emc.2014.09.010.

Sahin I, Onbasi K, Sahin H, Karakaya C, Ustun Y, Noyan T. The prevalence of pancreatitis in organophosphate poisonings. Hum Exp Toxicol. 2002;21(4):175–7.

Lee WC, Yang CC, Deng JF, Wu ML, Ger J, Lin HC, et al. The clinical significance of hyperamylasemia in organophosphate poisoning. J Toxicol Clin Toxicol. 1998;36(7):673–81.

Yoshida S, Okada H, Nakano S, Shirai K, Yuhara T, Kojima H, et al. Much caution does no harm! Organophosphate poisoning often causes pancreatitis. J Intensive Care. 2015 Apr 30;3(1):21. doi: 10.1186/s40560-015-0088-1.

Sahin I, Onbasi K, Sahin H, Karakaya C, Ustun Y, Noyan T. The prevalence of pancreatitis in organophosphate poisonings. Hum Exp Toxicol. 2002 Apr;21(4):175-7. doi: 10.1191/0960327102ht234cr.

Harputluoğlu MM, Kantarceken B, Karincaoglu M, Aladag M, Yildiz R, Ates M, et al. Acute pancreatitis: an obscure complication of organophosphate intoxication. Hum Exp Toxicol. 2003 Jun;22(6):341-3. doi: 10.1191/0960327103ht347cr

Hsiao CT, Yang CC, Deng JF, Bullard MJ, Liaw SJ. Acute pancreatitis following organophosphate intoxication. J Toxicol Clin Toxicol. 1996;34(3):343-7. doi: 10.3109/15563659609013800.

Roeyen G, Chapelle T, Jorens P, de Beeck BO, Ysebaert D. Necrotizing pancreatitis due to poisoning with organophosphate pesticides. Acta Gastroenterol Belg. 2008 Jan-Mar;71(1):27-9. PMID: 18396746.