The Curious Case of Opioid-Induced Pancreatitis

While most cases are known to be caused by gallstones or alcohol, a myriad of other causes have also been identified; medications being one of them. A wide array of medications have robustly been proven to cause pancreatitis 1 Opioid-induced pancreatitis, specifically, is less well documented. Only a handful of cases have been published, with Codeine being implicated as the trigger.2–7 Interestingly, these Codeine pancreatitis cases are almost exclusively seen in post-cholecystectomy patients.2–7 This is the case of a 54-year-old female presenting to the emergency department with acute-onset severe, crampy, epigastric pain, radiating to her back. The patient had accidentally ingested Acetaminophen with Codeine, thinking it was a sleeping aid. Approximately one hour after the ingestion, her symptoms began. The pathophysiology of opioid-induced pancreatitis is reviewed, with the proposed mechanism of codeine-induced Sphincter of Oddi spasm. In conclusion, opioid-induced acute pancreatitis in post-cholecystectomy patients has been well-established but surprisingly under-documented. There is tangible and pragmatic clinical importance, as clinicians should consider the increased risk of acute pancreatitis in patients with prior cholecystectomy, when prescribing opioid medications. Should a clinician find themselves with this patient presentation, naloxone seems to be an effective treatment, along with standard pancreatitis treatment, and discontinuation of the offending agent.