title: Obscured hemorrhagic pancreatitis after orthotopic heart transplantation complicated with acute right heart failure and hepatic dysfunction: a case report.
abstract: BACKGROUND
  Pancreatitis is a serious complication after cardiac surgery and can lead to significant morbidities and mortality. The incidence of pancreatitis is even higher in patients undergoing heart transplantation than in those undergoing other cardiac surgeries. Nevertheless, the clinical presentations of pancreatitis are frequently atypical in these patients.
  
  
  METHODS
  We report a heart recipient who was complicated with acute right heart failure initially after orthotopic heart transplantation and developed devastating unanticipated hemorrhagic pancreatitis 1 month after the transplantation. This crypto-symptomatic pancreatitis was not diagnosed until massive internal bleeding and hemorrhagic shock occurred, because the typical presentations of acute pancreatitis were masked by the intra-abdominal manifestations caused by right heart failure and congestive liver dysfunction. The patient underwent a successful transarterial embolization.
  
  
  CONCLUSIONS
  The causes of pancreatitis after heart transplantation include low cardiac output, immunosuppressant use and cytomegalovirus infection. The typical symptoms of pancreatitis might be not apparent in patients after heart transplantation because of their immunosuppressive status. Furthermore, in patients complicated with right heart failure after transplantation, the manifestation of pancreatitis could be even more obscure. The prompt diagnosis is highly depended on the clinician's astuteness.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, 70428, Taiwan.
authors.forename: Ting-Wei
authors.initials: TW
authors.lastname: Lin
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, 70428, Taiwan.
authors.forename: Meng-Ta
authors.initials: MT
authors.lastname: Tsai
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, 70428, Taiwan.
authors.forename: Jun-Neng
authors.initials: JN
authors.lastname: Roan
authors.affiliation: Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Liu
authors.affiliation: Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Hong-Ming
authors.initials: HM
authors.lastname: Tsai
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, 70428, Taiwan. luochwya@mail.ncku.edu.tw.|Cardiovascular Research Center, National Cheng Kung University, Tainan, Taiwan. luochwya@mail.ncku.edu.tw.
authors.forename: Chwan-Yau
authors.initials: CY
authors.lastname: Luo
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D006333:Heart Failure / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008107:Liver Diseases / Q000209:etiology; D008297:Male; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis; D012771:Shock, Hemorrhagic / Q000209:etiology
keywords: Case report; Heart transplantation; Pancreatitis; Right heart failure