Critical Care and Shock

Cardiac tamponade in acute necrotising pancreatitis

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Objective: This case report highlights cardiac tamponade as a potentially significant complication of severe acute pancreatitis.

Settings: This patient was admitted to the Ng Teng Fong general hospital emergency department. He was subsequently admitted to the Intensive Care Unit (ICU) in the same hospital.

Patients: A 58-year-old male presented with severe acute gallstone pancreatitis with a Glasgow-Imrie criteria of 3. He was admitted for haemodynamic instability and acute respiratory distress syndrome (ARDS). The patient developed new-onset atrial fibrillation, persistent hypotension despite fluid resuscitation and increasing dependence on high inotropic support.

Investigations: A CT abdomen incidentally discovered an accumulation of pericardial fluid. Bedside echocardiography confirmed the presence of a large pericardial effusion consistent with cardiac tamponade. A CT scan revealed severe necrotising pancreatitis with a significant peripancreatic fluid collection.

Interventions: An emergency pericardiocentesis was performed and a pericardial drain was inserted. Eight hundreds ml of haemoserous pericardial fluid was drained over a period of 2 days. The patient’s haemodynamic status improved significantly after drainage of pericardial fluid.

Conclusion: Cardiac tamponade is one of the rare but clinically significant complications of severe acute pancreatitis and should be treated with a high index of suspicion in cases of acute pancreatitis with hypotension.

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