Rahimipour Anaraki Shiva, Gholizadeh Mesgarha Milad, Bahadorizadeh Leyla, Hassanzadeh Morteza
Faculty of Medicine Iran University of Medical Sciences (IUMS) Tehran Iran.
Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases Iran University of Medical Sciences (IUMS) Tehran Iran.
Clin Case Rep. 2023 Oct 10;11(10):e8037. doi: 10.1002/ccr3.8037. eCollection 2023 Oct.
Physicians must be alert for the exocrine pancreatic insufficiency diagnosis through the follow-up of postgastrectomy patients, regardless the severity and lag time. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.
It is documented that exocrine pancreatic insufficiency (EPI) can develop after gastrectomy. Steatorrhea, malnutrition, and weight loss are common symptoms of the disease; however, it is usually mild to moderate postgastrectomy. This article reports a case of EPI manifested by hypoalbuminemia leading to dyspnea and anasarca, which are not typical symptoms of postgastrectomy EPI. A 61-year-old man with a history of gastric adenocarcinoma treated by total gastrectomy and chemoradiotherapy was admitted to the hospital with dyspnea and anasarca. Despite being diagnosed as a case of malignancy recurrence in another hospital, based on the symptoms described, no evidence of malignancy was found. His ascites and pleural effusion were determined to be caused by hypoalbuminemia. In addition, he claimed steatorrhea, and his stool elastase was lower than expected. EPI was diagnosed based on his medical history, paraclinical tests, and examinations. He remained asymptomatic for 1 year after being treated with albumin and pancreatic enzymes. Postgastrectomy EPI may be severe enough to cause steatorrhea or hypoalbuminemia. Hence, regardless of the severity of the presentation, physicians must be alert for this diagnosis throughout the follow-up of patients with a history of gastrectomy. Urgent albumin and pancreatic enzyme replacement should be considered when diagnosed.
医生必须通过对胃切除术后患者的随访警惕外分泌性胰腺功能不全的诊断，无论其严重程度和延迟时间如何。确诊后应考虑紧急补充白蛋白和胰腺酶。
有文献记载，胃切除术后可发生外分泌性胰腺功能不全（EPI）。脂肪泻、营养不良和体重减轻是该病的常见症状；然而，胃切除术后通常为轻至中度。本文报告一例以低白蛋白血症导致呼吸困难和全身性水肿为表现的EPI病例，这些并非胃切除术后EPI的典型症状。一名61岁男性，有胃腺癌病史，接受了全胃切除术和放化疗，因呼吸困难和全身性水肿入院。尽管在另一家医院被诊断为恶性肿瘤复发，但根据所述症状，未发现恶性肿瘤证据。其腹水和胸腔积液被确定为由低白蛋白血症引起。此外，他自述有脂肪泻，粪便弹性蛋白酶低于预期。根据其病史、辅助检查和体格检查诊断为EPI。接受白蛋白和胰腺酶治疗后1年他一直无症状。胃切除术后EPI可能严重到足以引起脂肪泻或低白蛋白血症。因此，无论表现的严重程度如何，医生在对有胃切除病史的患者进行随访时必须警惕这一诊断。确诊后应考虑紧急补充白蛋白和胰腺酶。
