Acute necrotizing pancreatitis with walled off necrotic collection (WON)
Presentation
Acute abdominal pain since two weeks.
Patient Data
The pancreatic body and tail show large parenchymal heterogeneous cystic lesion showing heterogeneous necrotic center with marginal post contrast enhancement. This cystic lesion is connected to smaller collections abutting the anterior aspect of the pancreatic body.
The splenic vein is markedly attenuated.
Calcular gallbladder.
Case Discussion
Necrotizing pancreatitis represents a severe form of acute pancreatitis. It usually tends to occur early, within the first 24-48 hours, but can also rarely occur with subacute forms.
A key feature is a significant amount of pancreatic and peripancreatic tissue necrosis associated with pancreatitis.
Areas of necrosis are seen as non-enhancing low attenuating regions within the pancreas.
Fluid collections associated with necrotizing pancreatitis:
- acute necrotic collections (ANCs): in the first 4 weeks; non-encapsulated heterogeneous non-liquefied material
- walled-off necrosis (WON or WOPN): develop after 4 weeks; encapsulated heterogeneous non-liquefied material
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