Acute pancreatitis following sleeve gastrectomy with transit bipartition: A case report

Sleeve gastrectomy with transit bipartition (SG-TB) is an emerging metabolic and bariatric surgery (MBS) procedure for obesity and type 2 diabetes. Acute pancreatitis (AP) is a rare complication of other metabolic and bariatric surgery (MBS) procedures (incidence: 0.27%-3.6%), including Roux-en-Y Gastric Bypass (RYGB) and occurs after other MBS procedures such as Roux-en-Y Gastric Bypass (RYGB) and standard Laparoscopic Sleeve Gastrectomy (LSG), while no AP cases following SG-TB have been reported to date.

We describe a 41-year-old female patient with obesity and type 2 diabetes (BMI 30.6 kg/m²) who developed AP on the 3rd day after an uncomplicated laparoscopic SG-TB. She presented with epigastric pain radiating to the back, mild elevation of serum amylase and lipase and magnetic resonance imaging findings consistent with the diagnosis of mild AP according to the 2012 Revised Atlanta Criteria.

The patient had moderately elevated preoperative triglycerides (5.0 mmol/L), which was below the classical threshold of 11.3 mmol/L for hypertriglyceridemia-induced AP, thus serving as a background risk factor for the onset, with no other definite etiological factors. Conservative treatment resolved symptoms, pancreatic enzyme levels normalized on the 7th postoperative day, and she was discharged uneventfully.

This case highlights that AP should be included in the differential diagnosis of patients with abdominal pain in the early postoperative period after SG-TB. Biliogastric reflux-induced pancreatic duct hypertension following gastrojejunal anastomosis in SG-TB and iatrogenic mechanical/thermal injury may be the main pathogenic mechanisms, with the patient's metabolic status acting as a synergistic factor for early-onset AP.