Immediate-onset postoperative acute pancreatitis after thoracic decompression laminectomy: a case report and literature review

Introduction and importance: Postoperative acute pancreatitis is uncommon after non-abdominal surgery and is mostly described after pediatric scoliosis correction in low body mass index (BMI) patients with intraoperative hypotension. Immediate onset after thoracic decompression in an obese adult with stable hemodynamics has not been reported. Case presentation: ) underwent elective T9-T11 decompressive laminectomy for thoracic spinal cord compression. Surgery was performed prone on chest rolls with the abdomen free, and intraoperative blood pressure remained stable without vasopressors. Within minutes of uneventful extubation, he developed severe epigastric pain. Serum amylase and lipase were elevated, and contrast-enhanced computed tomography showed focal interstitial pancreatitis of the pancreatic head without gallstones. He was treated with bowel rest, intravenous fluids, and analgesia, with complete resolution of symptoms and normalization of pancreatic enzymes within 72 hours. Evaluation excluded biliary disease, alcohol misuse, hypertriglyceridemia, and drug or infection-related causes. Histopathology of the vertebral lesion confirmed tuberculosis, and he subsequently underwent staged thoracic fusion and instrumentation without recurrence of pancreatitis. Clinical discussion: The abrupt timing strongly suggests an intraoperative or positioning-related insult despite preserved systemic pressures. Plausible mechanisms include transient splanchnic hypoperfusion, occult abdominal or pancreatic compression, and microcirculatory dysfunction. Conclusion: Acute pancreatitis can arise immediately after thoracic spine surgery in the absence of classic risk factors. Vigilance for pancreatitis in patients with new-onset epigastric pain in the operating or recovery room enables timely diagnosis and supportive management.