Acute pancreatic necrosis

Case contributed by Dr Jeremy Jones

Presentation

65 year old male with abdominal pain and hypovolaemic shock.

Patient Data

Age: 65
Gender: Male

Admission scan

Modality: CT

The initial study underestimates the severity and extent of pancreatic necrosis

Week 2

Modality: CT

 However, at one week, there is very little enhancing gland and by week 3, only a couple of islands of enhancing pancreas remain.

Week 3

Modality: CT

By week three, maturation of the peri-pancreatic inflammatory change is occurring.  These are not true collections can tend to contain viscous fatty material.  As they mature and become fluid filled, they are termed pseudocysts.

Week 4

Modality: CT

During the 4th week, there was worsening abdominal distension and CT revealed peforation of the terminal ileum.  In theatre, the entire terminal ileum was necrotic and fell apart.

Post op

Modality: CT

Post hemi-colectomy and ileostomy

Foley catheter in the transverse colon.  Open abdominal wound. Contrast within the peritoneal space.

Case Discussion

Severe acute pancreatitis with extensive pancreatic necrosis and non-enhancement of the gland.  This cause in this case was gallstone disease.

The initial study underestimates the severity and extent of pancreatic necrosis.  However, at one week, there is very little enhancing gland and by week 3, only a couple of islands of enhancing pancreas remain.

By week three, maturation of the peri-pancreatic inflammatory change is occurring.  These are not true collections can tend to contain viscous fatty material.  As they mature and become fluid filled, they are termed pseudocysts.

During the 4th week, there was worsening abdominal distension and CT revealed peforation of the terminal ileum.  In theatre, the entire terminal ileum was necrotic and fell apart.

Following extensive resection of necrotic bowel, the patient has an open abdominal wound with multiple surgical drains, a Foley catheter in the transverse colon and an ileostomy.  Oral contrast is seen within peritoneal space.

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Case Information

rID: 13560
Case created: 22nd Apr 2011
Last edited: 7th Oct 2015
Inclusion in quiz mode: Included

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