There are several learning points from this longitudinal review of a patient's journey through necrotizing pancreatitis:

• in the first few days, reduced density of the pancreas may be due to edema rather than reduced enhancement, and necrosis of the gland is more readily apparent after 7 days, so be cautious of specifying that acute pancreatitis is of the necrotic subtype too early in the course of the illness
• the pancreatic and peripancreatic collections in necrotizing pancreatitis will be heterogeneous in density due to fat necrosis, and in the first 4 weeks are called acute necrotic collections
• after the first 4 weeks, enhancing margins appear although still with heterogeneous content, and these areas are then called walled-off necrosis
• this terminology has been developed by a multispecialty working group and is called the revised Atlanta classification
• gas within walled-off necrosis may be due to infection, or fistula formation to adjacent small or large bowel
• the cystogastrostomy stent migrated to the site of a suspected fistula between the walled-off necrosis and the large bowel, inadvertently but helpfully confirming the presence of a fistula
• portal vein thrombosis is an early complication of acute pancreatitis, and variceal development may complicate subsequent interventions
• patients with acute pancreatitis may have protracted inpatient stays with numerous imaging studies and interventional radiology procedures