Relapsing pancreatitis after combined anterior and posterior instrumentation for neuropathic scoliosis

We report a case of pancreatitis in a 28-year-old woman who underwent a combined anterior Zielke procedure followed by Luque-TSRH (Texas Scottish Rite Hospital) operation in the same session for severe polioscoliosis. To our knowledge, only one case of a child with acute pancreatitis after posterior instrumentation for spondylolisthesis has been reported. In the early postoperative period, the patient developed acute pancreatitis that was diagnosed by a marked increase in plasma amylase and was confirmed by ultrasonography. The symptoms of pancreatitis in this patient temporarily resolved a few weeks after conservative treatment (diet, infusions, antibiotics). Six, 16, and 32 months after the combined operation, there were repeated relapsing episodes of pancreatitis with elevated amylase levels and concomitant symptoms. In the last follow-up evaluation in December 1995, the patient was well and the amylase levels were within normal limits. Although the etiology of pancreatitis in this case is obscure, we believe that the correction of the severe biplane spinal deformity, achieved by the two major operations on the spine in the same session, may have contributed to the pathogenesis of the disease. This observation suggests that pancreatitis after major scoliosis surgery should be suspected when abdominal symptoms persist associated with elevated serum amylase levels. Some cases of acute pancreatitis, such as this case, can persist in chronic-relapsing form for long periods postoperatively.