Two cases of acute pancreatitis occurring during therapeutic hypothermia for severe brain injury: case report and literature review.

Background: Therapeutic hypothermia is increasingly utilized in the management of severe brain injury. While lowering the target temperature can improve neurological outcomes, it also raises the incidence of treatment-related complications. Acute pancreatitis occurring during therapeutic hypothermia is exceptionally rare. Our center encountered two such cases within a short period, prompting this report to enhance clinical awareness. Case presentation: Case 1: A 75-years-old female with intracerebral hemorrhage received therapeutic hypothermia (target 34 °C). On the second day, she developed acute pancreatitis, which resolved after hypothermia was discontinued. Case 2: A 62-years-old male with post-thrombectomy cerebral edema underwent hypothermia (33 °C-34 °C). Similarly, acute pancreatitis emerged on the second day and improved upon rewarming. In both cases, common etiologies of pancreatitis were excluded. The temporal association suggested a possible link to hypothermia. Conclusion: Acute pancreatitis during therapeutic hypothermia is exceedingly rare. Its cause is likely multifactorial, involving factors such as hypothermia itself and stress responses. Therefore, clinicians should be vigilant about this potential complication during therapeutic hypothermia to avoid delays in diagnosis and treatment.