Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2013.041
Autopsy and Case Reports
Article / Clinical Case Report

Unusual tomographic findings of complicated necrotizing pancreatitis

Rosa Maria Silveira Sigrist; Samira Ineida Morais Gomes; Daniela Tavares Possagnolo; Brenda Margatho Ramos Martines

Downloads: 4
Views: 1168

Abstract

Acute pancreatitis (AP) is a potential life-threatening disease, which originates from inflammatory involvement of the pancreas and surrounding tissues. Serious complications eventuate and treatment is difficult. AP is classified in both interstitial edematous pancreatitis, which occurs in 70-80% of patients, and necrotizing pancreatitis, which occurs in 20-30% of patients. Diagnosis is based on the presence of two of the following criteria: abdominal pain, increased serum determination of amylase and/or lipase more than three times the reference value, and characteristic tomographic findings. Among the latter, there is the pancreatic and surrounding tissue damage as well as that related to distant organ involvement. This case report shows the fatal case of a male patient with a history of heavy alcoholic abuse admitted with the diagnosis of necrotizing pancreatitis. The authors call attention to the unusual tomographic findings; namely, a huge duodenal hematoma and a large hemoperitoneum, ischemic involvement of the spleen and kidneys, as well as pancreatic and peripancreatic necrosis.
 

Keywords

Pancreatitis, Acute Necrotizing, Hemoperitoneum, Duodenal Diseases

References

De Campos T, Parreira JG, Utiyama E, Rasslan. Pesquisa nacional sobre condutas na pancreatite aguda. Rev Col Bras Cir. 2008;35(5):304-10. Portuguese. http://dx.doi.org/ [https://doi.org/10.1590/S0100-69912008000500006]10.1590/S0100-69912008000500006

Sakorafas GH, Tsiotou AG. Etiology and pathogenesis of acute pancreatitis: current concepts. J Clin Gastroenterol. 2000;30(4):343-56.

Trout AT, Elsayes KM, Ellis JH, Francis RI. Imaging of acute pancreatitis: prognostic value of computed findings. J Comput Assist Tomogr. 2010;34(4):485-95. http://dx.doi.org/ [https://doi.org/10.1097/RCT.0b013e3181d344ca].

Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379-400.

Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371(9607):143-52.

Sarr MG, Banks PA, Bollen TL, et al. Revision of the Atlanta classification of acute pancreatitis. Gut. 2013;62(1):102-11.

Baron T. Managing severe acute pancreatitis. Cleve Clin J Med. 2013;80(6):354-9. http://dx.doi.org/ [https://doi.org/10.3949/ccjm.80gr.13001].

Turner M. Pancreatitis: role of US and CT. Gastrointest Endosc. 2002;56(6, Suppl):S241-5.

Thoeni R. The Revised Atlanta Classification of Acute Pancreatitis: its importance for the radiologist and Its effect on treatment. Radiology. 2012;262(3):751-64. http://dx.doi.org/ [https://doi.org/10.1148/radiol.11110947].

Bollen TL, Singh VK, Maurer R, et al. Comparative evaluation of the modified CT severity index and CT severity index in assessing severity in acute pancreatitis. AJR Am J Roentgenol. 2011;197(2):386-92. http://dx.doi.org/ [https://doi.org/10.2214/AJR.09.4025].

Bharwani N, Patel S, Prabhudesai S, Fotheringham T, Power N. Acute pancreatitis: the role of imaging in diagnosis and management. Clin Radiol. 2011;66(2):164-75. http://dx.doi.org/ [https://doi.org/10.1016/j.crad.2010.09.003].

Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603-13.

Isenmann R, Buchler M, Uhl W, Malfertheiner P, Martini M, Beger HG. Pancreatic necrosis: an early finding in severe acute pancreatitis. Pancreas. 1993;8(3):358-61.

Flati G, Salvatori F, Porowska B, et al. Severe hemorrhagic complications in pancreatitis. Ann Ital Chir. 1995;66(2):233-7.

Bretagne JF, Heresbach D, Darnault P, et al. Pseudoaneurysm and bleeding psedocysts in chronic pancreatitis: radiological findings and contribution to diagnosis in 8 cases. Gastrointest Radiol. 1990;15(1):9-16. http://dx.doi.org/ [https://doi.org/10.1007/BF01888725].

Sand JA, Seppanen SK, Nordback IH. Intracystic hemorrhage in pancreatic pseudocysts: initial experiences of a treatment protocol. Pancreas. 1997;14(2):187-91. http://dx.doi.org/ [https://doi.org/10.1097/00006676-199703000-00012].

Ma JK, Ng KK, Poon RT, Fan ST. Pancreatic-induced intramural duodenal haematoma. Asian J Surg. 2008;31(2):83-6. http://dx.doi.org/ [https://doi.org/10.1016/S1015-9584(08)60063-9].

Bodnar Z, Várvölgyi C, Tóth J, Sápy P, Kakuk G. Intramural duodenal hematoma complicating acute necrotizing pancreatitis. Gastrointest Endosc. 2000;52(6):791-3.

Federle MP, Goldberg HI, Kaiser JA, Moss AA, Jeffrey RB Jr, Mall JC. Evaluation of abdominal trauma by computed tomography. Radiology. 1981;138(3):637-44.

Turner A. The role of US and CT in pancreatitis. Gastrointest Endosc. 2002;56(6, Suppl):S241-5.

Petejova N, Martinek A. Acute kidney injury following acute pancreatitis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013;157(2):105-13. http://dx.doi.org/ [https://doi.org/10.5507/bp.2013.048].

Siu T. Percutaneous drainage of spontaneous subcapsular haematoma ofthe spleen complicating chronic pancreatitis. Surgeon. 2004;2(1):52-5.

Tutcu S, Serter S, Kaya Y, et al. Hepatic perfusion changes in an experimental model of acute pancreatitis: Evaluation by perfusion CT. Eur J Radiol. 2010;75(2):203-6. http://dx.doi.org/ [https://doi.org/10.1016/j.ejrad.2009.04.072].


 


Publication date:
01/13/2016

569696ad64cc8b5cda711be0 autopsy Articles

Autops Case Rep

Share this page
Page Sections