Hemorrhagic pancreatitis

Case contributed by Bruno Di Muzio
Diagnosis almost certain


Acute alcoholic pancreatitis. Drop in hemoglobin levels from 141 to 66 in between the admission and 4th day. Abdominal bleeding?

Patient Data

Age: 45 years
Gender: Male

CT A/P admission


Marked upper abdominal free fluid localized around the pancreas, encapsulating it. Pancreas is edematous and shows some wispy hypoenhancing regions. No pancreatic duct dilation or focal pancreatic lesion. No adjacent portal vein tributary thrombosis. 

CT A/P 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 edema. 

Case Discussion

This case shows hemoperitoneum on a background of necrotizing pancreatitis

Hemorrhage can occur in patients with severe necrotizing pancreatitis or as a result of the rupture of a pancreatic pseudoaneurysm, when it constitutes a life-threatening emergency. ​

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