A Case Report of Biliary Colics Resembling Iterative Acute Pancreatitis (Stress Induced Through Vagal Innervation into Vaterian Duodeno-pancreas): 2564

A 51-year-old female presented to our Clinic with a third episode of epigastric pain, without any radiation and afebrile. Abdominal ultrasound did not reveal any abnormality. All blood parameters were normal, except lipase (779 UI/L) without modification of amylase. During a one year lapse she have had two similar episodes, that is epigastric pain, without fever, high lipase and normal amylase. She had been admitted to two different Clinics and, after a short lapse, not more than 48 hs, discharged. In the last Clinics she was diagnosed of suffering of “iterative acute pancreatitis”. Deepening into her background she confessed that her troubles had started a few hours after suffering a violent discussion with her husband. Before this incident, there was nothing remarkable concerning her past medical history. In the last, present admission, her study was completed with abdominal ultrasound, computed tomography and bilio-pancreatic magnetic resonance. All were totally normal. There was not any sign of inflammation in her abdomen. Her pancreas perfectly intact. The only blood abnormality was a high lipase value that returned to normal level 48hs after. Conclusion According to our view, when analyzing the whole picture, that there is no doubt that through an undeniable stress (divorce) she suffered a predominant vagal cholinergic discharge with the neural impulses impinging upon essentially in what we have described, since the seventies, as the “trigger” (peri-vaterian region) of the pancreatic revolver. The logical consequence being a marked enhancing of the intrapancreatic cholinergic tone, which it should be emphasized is the mechanism responsible of the synthesis and secretion of lipase.1-2 The latter was amply proved by us in Marseille and Mt Sinai3-4 studying the effects of ethanol in humans, dogs and rats. From all the above facts, it is our conviction that the true diagnosis of the present report case is just a biliary-pancreatic colic (ductal hypertension) without any real inflammatory involvement of the pancreatic gland.