Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. ntergtlwrzn ihamnmlperleuin ec,ptetwsamte otehsia with hospital the zone to lower admitted right was Piperacillin/tazobactam with antibiotic patient =1) empirical commenced. Hence, with score management was Conservative (Ranson’s effusion. Pancreatitis effusion. pleural acute pleural were and minimal induced pneumonia test a Hypertriglyceridemia sugar: of coagulase with consolidation diagnosis zone and blood found the X-ray lower test chest Random right postero-anterior function echotexture A mg/dl, the heterogeneous Renal (Fig.1). with 12.1 in abnormality edematous test, significant showed other Nitrogen: function abdomen without of pancreas, Liver Urea of (USG) Ultrasonography The Blood limit. mg/dl, normal mg/dl. within 7.5 523 triglycerides: calcium: 120mg/dl U/L, 225 was rectal dehydrogenase: 16,300/cumm vault. 330,000/cumm examination The rectal count: physical Total count: evacuated rigidity. His an platelet follows: or and as were foods. blood guarding, He parameters of oily Objective rebound, vomiting. absence and without the of greasy, pain, for tenderness episode meat, abdominal notable periumbilical one from was diffuse and and fats examination of nausea epigastric saturated hours with of for associated five diet significant regions, a with periumbilical eating department and endorsed to emergency epigastric due to to pancreatitis presented localized acute gentleman with 39-year-old presented A who patient 39-year-old or report a Case genetic appendicitis. present by acute we influenced developed concurrently report, be who may case hypertriglyceridemia and brief infection this or department.In unknown. obstruction, emergency remains luminal visit largely direct to but patients by factors, for environmental caused reason typically surgical pancreatitis. is acute leading abdominal of dicitis a factor acute is risk a appendicitis for considered Acute are (2mmol/l) room and 177mg/dl than emergency infection greater levels conditions, the triglyceride metabolic fasting in some diagnoses cholangiopancreatography, retrograde common hypertriglyceridemia. endoscopic most alcohol, the stone, of one pain. is pancreatitis Acute complication a including as be part Introduction could colonic appendicitis adjacent acute the secondary in extrinsic, occurs that commonly showed most case pancreatitis. and This acute rare of colon. quite flexure is splenic pancreatitis and transverse acute in involvement colonic The Abstract 2021 1, March 2 1 kadel dhruba report case acute A induced pancreatitis: hypertriglyceridemia to secondary appendicitis Acute ainlAaeyo eia cecs ainlTam Center Trauma National Sciences, Medical of Academy National Hospital Adventist Memorial Scheer 1 aycuaieaet aebe eonzdi eeomn fauepnraii nldn gall- including pancreatitis acute of development in recognized been have agents causative Many 1 ai chaulagain sabin , 2 vntog hr sn osnu ndansi hehl ftilcrd ee,non- level, triglyceride of threshold diagnostic on consensus no is there though Even 3 eu iae 10UL(irslps;nra ag 330/) lactate 23-300U/L), range normal lipase; (Vitros U/L 2100 lipase: Serum , 1 iahthapa bikash , 4 1 2 neabasnet angela , 3 ihnurpis 0,hmtci:43%, hematocrit: 70%, neutrophils: with 1 n hsid Bhuju Shashinda and , 1 ct appen- Acute 1 3 Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 3 erprtna udtakdt h ih la os asdirtto frtoeioemlaigto leading retroperitoneum of irritation caused fossa iliac right the to inflammation tracked periappendicular fluid Retroperitoneal exudative was (3) scan CT the on observed pancreas was as of accumulated, fluid fluid following: retroperitoneal were the and fluid ultrasound of Peri-pancreatic (2) because repeat pancreatitis be acute and could to CT case led this analysis. Hypertriglyceridemia both in histopathological (1) However, observed the phenomenon by clinical confirmed appendicitis. the was echotexture acute believe fact heterogenous compared appendicitis. We this of and acute 81%, and bulky features diagnosing appendicitis of showed the acute admission for specificity of of not 95%, a suggestive time but of and the specificity pancreas at 86% patient and of of this can 94% on sensitivity the one of performed by a sensitivity pain, Ultrasound validated has tomography’s and abdominal ultrasound computed supported of perspective, to is context time. radiological diagnosis the specific a This in on From performed normal, pancreatitis. when acute of findings had limit CT lipase patient contrast upper and intravenous the amylase times that where appendicitis. three presentations conclude acute similar than safely of of more context literature elevated the clinical in reported. lipase the cases been in are have periappendicitis elevated there pancreatitis of that are acute cases aware the of of be as complication should handful with mechanism the patient One only unifying as the one literatures, patients of recovery with different published the was razor in the following Occam’s utilized appendicitis arises exploring be of and While question may case bias the intervention. classic confirmation surgical patient, a as a cautious this is be or workup. in must processes One observed biochemical separate answer? concurrently and two were to factors processes due risk this pathological history pancreatitis. distinct family acute two for and As factor social risk after known personal, pancreatitis a of acute is induced review Hypertriglyceridemia hypertriglyceridemia symptom-free. negative with be diagnosed otherwise was to an male found 39-year-old was this and summary, 5 14 In day (Fig. on clinic inflammation. lumen. postoperative acute and the Discussion mucosa periappendicular in the with up serosanguineous of followed appendicitis of sparing patient acute was mixture The with There the was subsequentc,d,e). consistent mesoappendix. Additionally, This output were and neutrophilic three. findings layer drain demonstrated normal. day propria These Appendix The muscularis postoperative were Vermiform the of on both days. of removed analysis infiltration histopathology amylase, and five (Fig. The decreased and at unremarkable. gradually lipase space. was sterile which recovery non- for was nature, periappendicular was in the measured fluid appendix ascitic from was the and of aspirated fluid of base was peritoneal culture The fluid The bacterial appendix. peritoneal of retrocecal a,b). inflamed, ml 5 an 100 the for Approximately on notable performed inflamed. were was findings placement of operative improvement drain to The show abdominal localized didn’t with (Fig.4) and admission. appendectomy ultrasound worsened of open and pain day an examination ninth abdominal physical Hence, his repeat status appendicitis. Upon clinical acute fossa. patient’s iliac the right of 200mg the improvement Octreotide initial the (Inj. therapy. After analogue supportive where somatostatin for intervention, a added nonsurgical acute was and a with parame- for Q8h) meropenem 6) opted these SC to CTSI team (CECT) in switched index; surgical tomography worsening severity was and computed CT the medical Piperacillin/tazobactam enhanced However, decreased (Modified Despite contrast pancreatitis a,b,c,d). calcium abdominal acute (Fig.3 fell. serum of appendicitis An analysis suggestive three, gas (Fig.2). features to the blood decreased deteriorated demonstrated lipase arterial score serum on Ranson’s the oxygen patient’s ters, of the pressure hours, partial and 48 following the Over 2 7,8 ae ntebohmclpol faserum a of profile biochemical the on Based 9 3 5,6 10 Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. .FrtrM,Ao A efrtdapniii aqeaiga ct acettsi obdyobese morbidly Report. a Case in A pancreatitis acute ; as masquerading Pancreatitis appendicitis Acute Perforated JA. of Akoh patient. Complication MJ, Forster a 7. As periappendicitis. with Appendicitis complicated N. pancreatitis 2016;21(3):199-201. Nozari Acute DW. Wong 6. (Taipei) M-L, Zhi Chen Za L-K, Xue Shoung Yi Zhonghua H-C, Hsia understanding modern 5. : management. appendicitis Acute and FT. , Drake JH, diagnosis 6736(15)00275-5 Assarsson Di, , S pathogenesis Saverio K, of Søreide A, Bhangu 4. Risk and Hypertriglyceridemia DISORDER. Mild-to-Moderate Pancreatitis. Nonfasting Cancer BG. Acute Nordestgaard Pancreatic of A, and Langsted SB, Pancreatitis retrospective. Pedersen of year 3. Epidemiology 35 The a AB. : Lowenfels ED troenterology D, the Yadav in 2. pain Abdominal RD. Powers doi:10.1016/j.ajem.2010.01.045 RS, 2011;29(7):711-716. Hastings 1. and article interest. this of edit Reference: conflict to no is us there assisting declare for Authors FACP, MBA interest MD case. of Thorp, this Declaration with Jonathon associated patient’s information Dr. of important thank up some providing to follow like information, would patient’s We Collecting Bhuju: Shashinda Acknowledgements paper. Dr. write to and helping Basnet condition, pancreatitis Angela acute to helping regarding and Dr. information finding the patient’s Exploring on interpretation Thapa: histopathological paper. Raj and write Bikash Radiological appendicitis, Dr. acute and and paper. Chaulagain writing Sabin and design Dr. concept Study Kadel: Dhruba Dr. hypothesize. mechanism. to pathophysiological attempted a have of List we elucidation that Authorship further mechanism unifying on de- a focus concurrently this is should pancreatitis there added studies acute think Future We We induced hypertriglyceridemia appendicitis. unknown. with acute is patient of veloped patient 39-year-old management this this the summary, helped in In reports. somatostatin Frankly, required case not case. been other this or even on in based have Whether failure therapy not antibiotic appendicitis. an may was patient’s antibiotics mechanism. there this pathophysiological mechanism, that unifying believe aforementioned a not the is do given we there perspective, that management pancreatitis. sense a acute makes From the it to course, unrelated the and time incidentally not the appendicitis but analysis given developed have However, appendicitis upon may acute seen patient the of was again, fluid lipase Once reactive and only amylase be normal may thus fluid exudate, intraperitoneal pancreatic observed appendicitis. operative acute Per to (5) progressed gradually inflammation periappendicular Acute (4) ol Gastroenterol J World 03146:2216.doi:10.1053/j.gastro.2013.01.068 2013;144(6):1252-1261. . AAnenlMed JAMAInternal 2008;14(11):1795-1796. . 2002;65(12):619-621. . 6 06162:8414.doi:10.1001/jamainternmed.2016.6875 2016;176(2):1834-1842. . Lancet 3 0536100:2818.doi:10.1016/S0140- 2015;386(10000):1278-1287. . mJEegMed Emerg J Am Govaresh Gas- . . Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. .c.()Msuai rpi ae hwn oeaet es etohlcifitainH&Esan(d) stain seen infiltration E Neutrophilic & (e) H stain infiltration E stain & neutrophilic E H & dense infiltration H to neutrophilic mesoappendix moderate no in showing showing 7cm Appendix layer measures of propria Appendix lumen Vermiform Muscularis Spared inflammation: Inflamed (c) acute (b) periappendiceal 1.5cm. Appendix. with Vermiform x appendix inflamed appendicitis of filled acute image fluid of Intraoperative of features (a) appearance microscopic target and shows:- Macroscopic region Fig.5: fossa iliac right of USG ( appendicitis. Acute enhancing mild 4: collection. with Fig. and fluid fluid periappendiceal with with with (11mm) caecum caecum and distended of displacing wall is stratification is appendix smooth retroperitoneum Mural retrocaecal in (b) periduodoneal demonstrates collection arrow). (c,d) Fluid and (black anteriorly. wall. peripancreatic fascia edematous in lateralconal circumferental by regular collection posteriorly symmetrical fluid limited with side reagent right along strandings with in (*) demonstrates level (a) pancreas lipase abdomen:- of of Serum CT ( process Contrast axis: uncinate appendicitis. Y the acute and admission; along pancreatitis hospital Acute of 3: Days Figure. axis: X level. lipase lipase vitros Serum (arrows pancreas 2: pancreas). of Figure echotexture of heteroechoic body demonstrates and abdomen neck upper head; USG showing pancreatitis. Acute Fig.1: Tomography Computed : Review Legends: Systematic Figure Review RJ. Kohlwes S, To. Bent Ultrasonography CC, and Blackmore pancreatitis. T, Acute Terasawa CM. 10. Pastor ML, Steer J, lipase. Frossard elevated 9. with appendicitis subhepatic Pediatric doi:10.1016/j.ajem.2018.09.039 A. Essenburg 2019;37(2019):174.e1-174.e3. SA, Mcaninch 8. ><< >> >> eodadtidpr fdoeem eino erprtnu.Fudi aaea retroperitoneum pararenal in Fluid retroperitoneum. of region duodeneum) of part third and second ihprapnielfe ud()cleto n mna hceig(ht arrow). (white thickening omental and collection (*) fluid free periappendiceal with ) n nenMed Intern Ann 2004;141(7):537-546. . 4 Lancet 2008;371:143-152. . mJEegMed Emerg J Am . Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 5 Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 6 Posted on Authorea 1 Mar 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.161455863.34030016/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 7