Paramjot Kaur*, Amit Kumar, Megha Chauhan, Nihal Negi and Sanjay Mahajan
Background: Acute necrotizing pancreatitis is an uncommon yet significant complication arising from organophosphate poisoning, a prevalent form of self-poisoning due to its widespread availability and potency. This case report details the presentation and management of a 28 years old female who ingested Dichlorvos, an organophosphate compound, and manifested with typical cholinergic symptoms, namely salivation, lacrimation, diarrhoea, excessive urination, emesis and pin point pupils. Initially, she was managed with atropine and pralidoxime. While these symptoms started improving with injectables, she developed severe epigastric pain within hours, leading to a diagnosis of acute necrotizing pancreatitis. It was confirmed by imaging and elevated pancreatic enzymes. Treatment involved intensive supportive care, fluid resuscitation, and pain management, resulting in gradual clinical improvement and discharge after eight days.
The discussion explores the pathophysiological basis of organophosphate-induced pancreatitis, attributing it to cholinergic overstimulation of pancreatic acinar cells and ductal hypertension. Reviewing pertinent literature underscores the rarity of this complication, emphasizing the importance of clinical vigilance in its recognition and timely intervention to mitigate potential morbidity and mortality. While routine pancreatic enzyme testing in all organophosphate poisoning cases is not recommended, awareness of this complication facilitates prompt diagnosis and targeted management, thereby optimizing patient outcomes. This case highlights the critical role of early intervention in managing uncommon but serious complications of organophosphate poisoning.
