Year: 2026
Type: article
Abstract: Introduction. Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP). Serum lipase may remain below three times the upper limit of normal (ULN), which delays diagnosis. Case presentation. A 29-year-old obese man (BMI 30 kg/m²) was admitted to the intensive care unit 72 h after the onset of epigastric pain radiating to the back. He had respiratory distress (PaO2/FiO2 120), KDIGO stage 3 acute kidney injury, thrombocytopenia (120,000/mm³) and hypocalcemia. The serum was lactescent, triglycerides were 9.57 g/L and lipase was 66 IU/L, below 3 × ULN. Computed tomography showed Balthazar grade E AP with pancreatic necrosis of less than 30% (CTSI 6). The modified Marshall score was 4 and three SIRS criteria were met. Other causes of AP were excluded, including biliary lithiasis by magnetic resonance cholangiopancreatography (MRCP). Organ failures were corrected with echocardiography-guided fluid resuscitation, norepinephrine, renal protective measures, oxygen therapy and non-invasive ventilation. HTG was treated with insulin, unfractionated heparin, fenofibrate and lipid-free parenteral nutrition; triglycerides decreased by 93% in 4 days without plasmapheresis. The patient was transferred to the gastroenterology department on day 5. Conclusion. Lipase below 3 × ULN does not rule out hypertriglyceridemic AP, including severe forms. Diagnosis then relies on clinical presentation, imaging and exclusion of other causes.
Institution: Mohammed V University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225794843