CT Abdomen and pelvis (4 days later)
The pancreas is enlarged and shows ill-defined hypoenhancing areas involving less than 30% of its volume, in keeping with necrotizing pancreatitis. Marked fat stranding and fluid around the pancreas, involving the left perirenal space, and both anterior pararenal spaces. There is a moderate to large amount of free fluid spread through the peritoneal cavity, showing an average attenuation value of 20 HU. No contrast blush identified.
No free gas in the abdominal cavity. Portal vein and splenic vein are patent. The bowel is not distended and has unremarkable appearances. A hiatus hernia again noted. Fatty liver. Contrast excretion noted within the gallbladder. The spleen, kidneys and adrenal glands are unremarkable. No lymph node enlargement.
Bilateral small pleural effusions with associated adjacent air space opacities, likely restrictive atelectasis. Diffuse mild subcutaneous oedema.