A Pancreas Out of Place: Acute Interstitial Pancreatitis Caused by Pancreatic Herniation in a Type IV Paraesophageal Hernia.

Pancreatic involvement in paraesophageal hernias is rare and can precipitate acute pancreatitis through mechanical compression or ischemia. We report an 82-year-old woman who presented with epigastric pain and an elevated lipase level. Imaging demonstrated a large type IV paraesophageal hernia containing the stomach, transverse colon, and pancreatic body and tail, with inflammatory changes localized to the pancreatic tail. Common causes of pancreatitis were excluded. The patient improved with conservative management and was referred for elective hernia repair after resolution of pancreatitis. This case highlights an uncommon mechanical cause of acute pancreatitis and the importance of anatomic evaluation in atypical presentations.