Walled off pancreatic necrosis

Case contributed by Dr Ian Bickle


Gallstone pancreatitis. CBD stent insertion. Distended abdomen and vomiting.

Patient Data

Age: 60 years
Gender: Female


Common bile duct stent with air in the biliary tree in keeping with recent hepatobiliary intervention.

Large thin walled cyst in the head and neck of pancreas displacing and compression the antrum of the stomach. Loss of pancreatic bulk in the pancreatic head and neck. There is a small amount of debris within the peripancreatic collection. Peripancreatic inflammatory change and small volume pelvic free fluid.

The stomach is distended with fluid suggesting a degree of outlet obstruction.

Fatty liver.

Fibroid uterus.

Case Discussion

Walled off pancreatic necrosis and pseudocysts occur 4 weeks after a bout of pancreatitis. They may be symptomatic due to a gastric outlet or biliary obstruction. Before this time they are termed "acute necrotic collections" or "acute peripancreatic fluid collections", respectively.

One form of treatment is a through drainage into the stomach (cyst gastrotomy) or less commonly percutaneously.

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