Ischemic Acute Necrotizing Pancreatitis

Johannes Matthias Löhr, Åke Andrén-Sandberg
Department of Surgical Gastroenterology, Karolinska University Hospital at Huddinge,
Karolinska Institute. Stockholm, Sweden
Dear Sir:
we read the contribution by Mast et al. with great
interest [1]. They report on this unfortunate gentleman
who developed acute pancreatitis after running
marathon and taking a sauna. Although this
combination of physical activities is not so uncommon
in the Nordic countries, particularly during winter time,
no such experience or reports exist on pancreatitis.
Morbidity and mortality of sauna bathing is rather low
[2], despite the fact that there is a readiness to combine
sauna with alcohol intake. The more this case report
appears worth publishing, even though we should have
appreciated some more data on the level of
hemoconcentration in this runner and sauna bather.
Furthermore, as it is routine in our pancreas clinic these
days, we would have searched also for one of the
known genetic factors contributing to the development
of pancreatitis such as mutations in PRSS1SPINK1,
CFTR and CTRC genes [3]. Even more though in a
patient who does not have one of the known or obvious
causes such as alcohol, gallstones or hyperlipidemia.
Further, despite his obvious physical condition, the
presence of atherosclerotic microangiopathy would be
worth knowing in a 57-year-old man, since most of the
ischemic etiologies are thought to be associated with
atherosclerotic disease [4].
Conflict of interest The authors have no potential
conflicts of interest
References
1. Mast JJ, Morak MJ, Brett BT, van Eijck CH. Ischemic acute
necrotizing pancreatitis in a marathon runner. JOP. J Pancreas
(Online) 2009; 10:53-4. [PMID 19129616]
2. Kenttämies A, Karkola K. Death in sauna. J Forensic Sci 2008;
53:724-9. [PMID 18471223]
3. Keim V. Role of genetic disorders in acute recurrent pancreatitis.
World J Gastroenterol 2008; 14:1011-5. [PMID 18286680]
4. Sakorafas GH, Tsiotos GG, Bower TC, Sarr MG. Ischemic
necrotizing pancreatitis. Two case reports and review of the
literature. Int J Pancreatol 1998; 24:117-21. [PMID 9816545]
Received January 26th, 2009
Key words chymotrypsin C; Cystic Fibrosis Transmembrane
Conductance Regulator; Genetic Predisposition to Disease;
Heredity; Pancreatitis; PRSS1 protein, human; Running; Shock;
SPINK1 protein, human; Steam Bath
Abbreviations CFTR: cystic fibrosis transmembrane conductance
regulator (ATP-binding cassette sub-family C, member 7); CTRC:
chymotrypsin C (caldecrin); PRSS1: protease, serine, 1 (trypsin 1);
SPINK1: serine peptidase inhibitor, Kazal type 1
Correspondence Johannes Matthias Löhr
 

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