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Acute pancreatic necrosis

Case contributed by Jeremy Jones
Diagnosis certain

Presentation

Abdominal pain and hypovolemic shock.

Patient Data

Age: 65 years
Gender: Male

Admission scan

ct

The initial study underestimates the severity and extent of pancreatic necrosis

Week 2

ct

However, at one week, there is very little enhancing gland and by week 3, only a couple of islands of enhancing pancreas remain.

Week 3

ct

By week three, maturation of the peripancreatic inflammatory change is occurring. These are not true collections can tend to contain viscous fatty material.  As they mature and become fluid-filled, they are termed pseudocysts.

Week 4

ct

During week 4, there was worsening abdominal distension and CT revealed peforation of the terminal ileum.  In theater, the entire terminal ileum was necrotic and fell apart.

Post op

ct

Post hemicolectomy and ileostomy

Foley catheter in the transverse colon.  Open abdominal wound. Contrast within the peritoneal space.

Case Discussion

Severe acute pancreatitis with extensive pancreatic necrosis and non-enhancement of the gland.  This cause in this case was gallstone disease.

The initial study underestimates the severity and extent of pancreatic necrosis.  However, at one week, there is very little enhancing gland and by week 3, only a couple of islands of enhancing pancreas remain.

By week three, maturation of the peripancreatic inflammatory change is occurring. These are not true collections and tend to contain viscous fatty material. As they mature and become fluid-filled, they are termed pseudocysts.

During the 4th week, there was worsening abdominal distension and CT revealed perforation of the terminal ileum. In theater, the entire terminal ileum was necrotic and fell apart.

Following extensive resection of necrotic bowel, the patient has an open abdominal wound with multiple surgical drains, a Foley catheter in the transverse colon and an ileostomy.  Oral contrast is seen within peritoneal space.

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