Epigastric pain, radiating to the back.
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Within the abdomen there is ascites with fluid seen superior to the liver. The pancreas appears swollen but does enhance uniformly and there is significant oedema in the peri-pancreatic and retro-peritoneal fat throughout the abdomen. The free fluid is seen tracking to a collection within the pelvis. No definite abscess or pseudocyst collection seen.
There is hydronephrosis of the atrophic right kidney. Left nephrectomy noted. The transplant kidney is in the right iliac fossa and is unobstructed. Gas is seen throughout the colon and small bowel in keeping with an ileus but no definite bowel obstruction.
This patient was 5 days post laparoscopic cholecystectomy after an attack of biliary colic and was admitted with severe epigastric pain and tenderness. The features are in keeping with acute pancreatitis. He was treated conservatively on the ward in the HDU.