Novembre 2026 - Volume XLV - numero 9
Casi contributivi
1UOC di Pediatria, Ospedale di Ravenna, AUSL della Romagna
2Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna
3Scuola di Specializzazione in Pediatria, Alma Mater Studiorum, Università di Bologna
4Medicina interna Cardiovascolare, IRCCS “S. Orsola”, Università di Bologna
Key words: Acute necrotising pancreatitis, Severe hypertriglyceridemia, Paediatric gastroenterology, Insulin therapy
Background: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is a well-recognised but relatively uncommon condition in paediatric patients.
Case presentation: This article reports the case of a previously healthy 13-year-old girl with a history of incidental dyslipidaemia who presented with acute severe abdominal pain and vomiting. Laboratory tests showed marked lipemia, neutrophilic leucocytosis and elevated lipase levels and led to the diagnosis of acute pancreatitis according to Atlanta criteria. Abdominal CT revealed early pancreatic necrosis with peripancreatic fluid collection. Severe hypertriglyceridemia (> 4425 mg/dl) was identified as the likely aetiology. The patient was treated with fasting, intravenous fluids, analgesia and insulin infusion with dextrose, and showed a progressive reduction in triglyceride levels and clinical improvement. The clinical course was complicated by fever and inflammatory marker elevation, requiring escalation of antibiotic therapy. Imaging later detected a large organised peripancreatic fluid collection, which was managed conservatively.
Outcome: The patient showed gradual clinical and biochemical recovery, with triglyceride levels decreasing to 500 mg/dl. Secondary causes of hypertriglyceridemia were excluded. Despite the suspicion of a primary genetic dyslipidaemia, genetic testing was negative. Discharge was arranged on a low-fat diet and omega-3 supplementation with planned follow-up.
Conclusions: This case highlights the importance of considering hypertriglyceridemia in paediatric acute pancreatitis and supports the effectiveness of insulin therapy in rapidly reducing triglyceride levels. The absence of a genetic diagnosis suggests a potentially multifactorial or transient aetiology and calls for further investigation.
Ragazza di 13 anni, precedentemente in buona salute e con un’anamnesi di dislipidemia rilevata casualmente, si è presentata con dolore addominale acuto e severo e vomito. Gli esami di laboratorio hanno mostrato una marcata lipemia, leucocitosi neutrofila ed elevati livelli di lipasi, portando alla diagnosi di pancreatite acuta secondo i criteri di Atlanta. La TC addome ha rivelato una necrosi pancreatica precoce con raccolta fluida peripancreatica. L’ipertrigliceridemia severa (> 4.425 mg/dl) è stata identificata come la probabile eziologia. La paziente è stata trattata con digiuno, fluidoterapia endovenosa, analgesia e infusione di insulina con destrosio, ottenendo una progressiva riduzione dei livelli di trigliceridi e un miglioramento clinico. Il decorso clinico è stato complicato da febbre e aumento dei marcatori infiammatori, richiedendo l’intensificazione della terapia antibiotica. Successivi esami di imaging hanno dimostrato un’ampia raccolta fluida peripancreatica organizzata, gestita con approccio conservativo.
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