Ahmed Hussein Mahdi, Osman Mohamed Hassan, Hassan Shafie Abdulkadir, Dirie Hassan Mohamud, Mohamed Mowlid Abdikarin
Department of Internal Medicine, Royal Hospital, Mogadishu, Somalia.
Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia.
Int Med Case Rep J. 2025 May 30;18:645-649. doi: 10.2147/IMCRJ.S516349. eCollection 2025.
Hypertriglyceridemia (HTG) is a known but relatively uncommon cause of acute pancreatitis (AP), accounting for approximately 1-7% of cases. Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) can lead to significant morbidity if not promptly identified and managed. This case report describes a patient with poorly controlled type 2 diabetes mellitus (T2DM) who presented with HTG-AP, characterized by a lipemic blood sample, in a resource-limited setting.
A 45-year-old male with a history of poorly controlled T2DM and hyperlipidemia presented with a 24-hour history of severe epigastric abdominal pain, fatigue, and vomiting. Clinical examination revealed diffuse abdominal tenderness, tachypnea, tachycardia, and a habitus consistent with central obesity. His BMI was 33.2 kg/m². Initial laboratory findings included seriously elevated triglycerides (1509 mg/dL), lipase (83 U/L), and amylase (161 U/L), along with hyperglycemia (465mg/dL). Abdominal computed tomography (CT) scan showed peripancreatic fatty stranding, consistent with early acute pancreatitis, as well as a fatty liver and a focal hypodense lesion in the right lobe. Treatment included intravenous insulin, dextrose, and potassium infusions to reduce triglyceride levels, analgesics, intravenous fluids for electrolyte imbalances, and thromboprophylaxis with enoxaparin.
This case highlights the importance of early recognition of HTG-AP in patients with poorly controlled diabetes and hyperlipidemia. Prompt triglyceride-lowering therapy, primarily with insulin in resource-limited settings, is crucial for improving patient outcomes and preventing complications.
高甘油三酯血症（HTG）是急性胰腺炎（AP）一种已知但相对不常见的病因，约占病例的1-7%。如果不及时识别和处理，高甘油三酯血症性急性胰腺炎（HTG-AP）可导致严重的发病率。本病例报告描述了一名2型糖尿病（T2DM）控制不佳的患者，在资源有限的情况下出现了以脂血样本为特征的HTG-AP。
一名45岁男性，有T2DM控制不佳和高脂血症病史，出现了24小时的严重上腹部腹痛、疲劳和呕吐。临床检查发现弥漫性腹部压痛、呼吸急促、心动过速，体型符合中心性肥胖。他的体重指数为33.2kg/m²。初始实验室检查结果包括甘油三酯严重升高（1509mg/dL）、脂肪酶（83U/L）和淀粉酶（161U/L），以及高血糖（465mg/dL）。腹部计算机断层扫描（CT）显示胰腺周围脂肪条索，符合早期急性胰腺炎，同时还有脂肪肝和右叶局灶性低密度病变。治疗包括静脉注射胰岛素、葡萄糖和钾以降低甘油三酯水平、使用镇痛药、静脉输液纠正电解质失衡，以及使用依诺肝素进行血栓预防。
本病例强调了早期识别糖尿病和高脂血症控制不佳患者中HTG-AP的重要性。在资源有限的情况下，主要使用胰岛素进行迅速的降甘油三酯治疗，对于改善患者预后和预防并发症至关重要。
