PROGRESSION IN
LOCAL HOSPITAL
Ultrasound shows gallbladder stones.
On day 2, endoscopic ultrasound is performed
showing a stone in the main bile duct.
On day 4, endoscopic sphincterotomy removes
the stone.
But this is followed by clinical deterioration with
fever, chills and blood culture positive for E. Coli.
Antibiotic treatment is ineffective and the patient
is referred to the University Hospital on day 13.
INITIAL CT SCAN
The appearances on the are dramatic, with necrosis of the
peripheral areas of the pancreas, associated with a
heterogeneous collection, while the core of the gland
remains well perfused.
PROGRESSION IN UNIVERSITY
HOSPITAL
Fine needle aspiration under CT guidance
produces a purulent exudate containing Gramnegative rods (E. Coli).
The patient undergoes surgery on day 30.
Debridement of the necrotic tissue situated
around the gland results in large cavities, which
are then packed.
A jejunostomy and an ileostomy (with a view to
preventing colonic complications) are undertaken.
No biliary drainage is possible. Packing is
subsequently replaced by drains.
CASE SCENARIO
A 45-year-old alcoholic male, is admitted to a local
hospital with acute pancreatitis.
Severity criteria are not available, therefore the
Ranson score is unknown.
The general symptoms recede but pain recurs
following every attempt at feeding.
.
Secondary infection,
particularly when
organised necrosis is
mistaken as a pseudocyst
and cutaneous fistula,
especially if the
pseudocyst
communicates with the
pancreatic duct.
FOLLOW UP
The patient is discharged one month after operation with a
well fitted appliance to collect the fistula fluid.
Three months after operation, the pancreatic fistula is still
open.
An ERCP shows the duct in the head of the gland and a
fistulography outlines the remaining, glandular duct.
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