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Walled-off pancreatic necrosis

Case contributed by Mostafa Elfeky
Diagnosis probable

Presentation

Epigastric pain.

Patient Data

Age: 60 years
Gender: Male

CT abdomen with contrast

ct

The pancreas shows multiple ductal and parenchymal calcifications, as well as hypodensity of the tail, associated with multiple collections, mostly non-encapsulated, mainly in the lesser sac and porta hepatis, insinuating into the subcapsular and periportal spaces, in keeping with acute on chronic pancreatitis, with acute peripancreatic fluid collections.  

Portal thrombophlebitis involving the right posterior branch of the portal vein, associated with a small hepatic abscess in segments VII and VIII.

Mild ascites and bilateral minimal pleural effusions.

Generalized edema.

Case Discussion

Walled-off pancreatic necrosis occurs as a late complication of acute pancreatitis and can occur in chronic pancreatitis. It is not to be confused with pseudocyst, which occurs later than 4 weeks following pancreatitis and is more uniformly round with enhancing margins.

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