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Necrotizing pancreatitis

Case contributed by Wayland Wang
Diagnosis almost certain

Presentation

Abdominal pain.

Patient Data

Age: 35 years
Gender: Female
ct

Extensive regions of the pancreatic head and body show poor enhancement and are replaced by a large fluid density collection, consistent with necrosis. The pancreas is enlarged and edematous, with surrounding fat stranding and fluid tracking in the anterior pararenal spaces bilaterally and also extending into the pelvis.

These features are in keeping with severe necrotizing pancreatitis. There are peritoneal free fluid and bilateral pleural effusions. No radiopaque gallstones or biliary dilatation.

Two weeks later

ct

Cholecystectomy has been performed since the previous CT. The previously shown region of acute necrotic fluid has evolved into a more homogeneous fluid collection with a defined wall, with further small cystic components extending along the left retroperitoneum. The collection causes narrowing of the splenic vein, although the portal, splenic and superior mesenteric veins remain patent. There is minimal remaining enhancing pancreas a the tail.

Case Discussion

This case illustrates evolution of acute necrotizing pancreatitis, from acute necrotic collection on its way to becoming walled-off necrosis.

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