Acute pancreatitis

Case contributed by Dr Vikas Shah

Presentation

Severe epigastric pain.

Patient Data

Age: 20 years
Gender: Female

CT abdomen and pelvis

CT

The pancreas enhances normally but appears edematous. There is a large volume of fluid surrounding the pancreas, extending into the mesentery and into the anterior pararenal spaces bilaterally. The fluid is bound by fascial planes. There is no venous thrombosis, and no calcified gallstones are seen.

Case Discussion

In the first 72 hours following the onset of symptoms of acute pancreatitis, it is difficult to define the morphology (interstitial edematous type versus necrotizing type) accurately due to transient gland edema and hypoperfusion being similar in imaging appearance to ischemia and necrosis. Similarly, the fluid around the pancreas cannot be determined to be 'simple' or part of a necrotizing process. Therefore, in the early phase, it is advisable to make a diagnosis of acute pancreatitis with peripancreatic fluid, and use the terminology described in the revised Atlanta Classification after the 72 hour mark, when the imaging becomes clearer.

In this case, the clinical course was benign (mild acute pancreatitis) and no follow up imaging has been acquired.

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