S3637 Acute Pancreatitis Following Sleeve Gastrectomy: A Rare Postoperative Complication

Introduction: Laparoscopic sleeve gastrectomy (LSG) is widely performed as a last resort for weight loss in patients who have not succeeded with diet and lifestyle modifications. The procedure promotes weight loss by reducing stomach capacity and enhancing early satiety. While most patients tolerate the surgery well, it is not without complications. One rare but noteworthy complication is acute pancreatitis. Case Description/Methods: A 41-year-old woman with no known comorbidities presented for bariatric surgery. She was morbidly obese and had previously attempted many diet and lifestyle modifications, but couldn’t maintain them. She was counseled for LSG and consented to the procedure. Pre-operative evaluation revealed a slightly low hemoglobin level (11.8 g/dL), with normal WBC and platelet counts. Other investigations, like coagulation profile, thyroid function tests, renal function test, urinalysis, EKG and chest X-ray were within normal limits. Abdominal US Apart from moderate hepatic steatosis with mildly elevated AST (43.0 U/L) and ALT (62.0 U/L). Apart from these findings, the abdominal US was unremarkable. She was found fit for surgery and underwent LSG without intraoperative complications. On postoperative day 2, she developed abdominal pain, fever, nausea, and vomiting. Abdominal examination revealed epigastric tenderness and rigidity. Laboratory investigations showed leukocytosis (15,700/mm³) with neutrophilia (90%). On postoperative day 3, serum lipase and amylase levels were elevated at 175.2 U/L and 244.16 U/L, respectively. Based on physical and biochemical findings, a diagnosis of acute pancreatitis was made. Contrast-enhanced computed tomography of the abdomen revealed focal acute necrotizing pancreatitis. She was managed conservatively with intravenous fluids and analgesics. The patient’s condition improved, and she was discharged on postoperative day 5. A final diagnosis of acute pancreatitis following LSG was established. Discussion: This case highlights that LSG, while generally considered a safe and effective bariatric procedure, can occasionally be associated with unexpected complications such as acute pancreatitis. The exact mechanism behind this complication remains unclear; however, possible contributing factors include minor intraoperative trauma to the pancreas, irritation of the pancreatic or common bile ducts, or vascular injury. As LSG continues to gain popularity, it is essential for clinicians to remain vigilant for such rare but potentially serious complications.