Presentation
Pancreatitis, abdominal pain.
Patient Data
Medium left effusion with significant collapse of the left lung. Most of the pancreas enhances uniformly without ductal dilation, with some hypoenhancement versus fluid/thrombosed splenic vein insinuating about the tail. Extensive, dissecting peripherally enhancing and partially organized peripancreatic, retroperitoneal, and lesser sac collections displacing the stomach, transverse colon, ascending colon. Reactive submucosal edema of the right colon with ileus. Small bowel gas is equivocal for pneumatosis in several locations. Thrombosed splenic vein. Small ascites. Anasarca.
Case Discussion
Advanced presentation of severe pancreatitis with extensive organizing peripancreatic and retroperitoneal collections. Hetergeneous enhancement near the tail could be related to fluid, thrombosed splenic vein, or necrosis. Evaluating the relationship of the collections to surrounding structures helps us to expand our understanding of anatomy of the retropertineum (most) and lesser sac projecting anteriorly under the stomach and displacing the transverse colon.
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