Acute on chronic pancreatitis

Case contributed by Dr Jeremy Jones

Presentation

Flank pain with hydronephrosis demonstrated at ultrasound.

Calcification of the pancreas indicative of chronic pancreatitis.  

Generally, enhancement is preserved although there is some focal non-enhancement in the tail. No collection at present.

Marked peripancreatic inflammatory change with fluid extending into the small bowel mesenterytransverse mesocolon and down into the pelvis. Some areas of focal reduced enhancement. Bilateral pleural effusions. 

Chronic left-sided hydronephrosis with renal cortical thinning.

Case Discussion

It is likely that a peripancreatic collection will develop. These are often amenable to percutaneously drainage under CT guidance, but usually, do not require drainage in the acute setting.

Features of acute on chronic pancreatitis with inflammatory change and peripancreatic collection formation.

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