Presentation
Acute abdominal pain. Perforation? Pancreatitis?
Patient Data
Severe inflammatory changes of the pancreas with body and tail subtotal necrosis. Acute necrotic non-encapsulated collections around the pancreas, including the lesser sac and bilateral anterior pararenal spaces, are consistent with acute necrotic collections. Edematous changes of the head with some hypodense areas.
Splenic vein thrombosis is almost all of its length, with hypoperfusion of the spleen. Also, there is a small filling defect in the superior mesenteric vein near the confluence.
Presence of a hypoperfusion complex:
hyperenhancing small bowel walls
collapsed inferior vena cava
multiple small hypodense lesions of the kidneys (better visible on the arterial phase) - bilateral striated nephrogram
hyperenhancing adrenal glands
Case Discussion
Necrotizing pancreatitis - Balthazar E (score 4) with necrotic areas >50% (score 6) with a general score of 10.
Splenic vein thrombosis is a severe complication of pancreatitis.
Presence of a hypoperfusion complex.
Unfortunately, the patient died the next day.
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