Presentation
Recurrent episodes of upper abdominal pain which aggravates after taking a fatty meal.
Patient Data
Evidence of hypodense, small, sheet-like lesion in the pancreaticoduodenal groove with a relatively thickened wall of the second part of the duodenum and associated marked surrounding inflammatory stranding (which is extending into the mesentery, peri-renal space, and right para-colic gutter up to the right iliac fossa) are noted. The adjacent part of the pancreatic head also shows subtle changes, however, no definite lesion is appreciated.
Few dominant lymph nodes within peri-duodenal space are also noted.
A minimal amount of free fluid is seen in the pelvic cavity.
The liver is mildly enlarged in size with a normal position and has smooth borders. The liver is showing a decrease in density as compared to the splenic parenchyma on the venous phase which is most likely due to diffuse fatty changes in hepatic parenchyma, however no discrete focal lesion is appreciated in hepatic parenchyma. The internal structure and attenuation values are normal. The hepatic and portal veins are patent. The intra hepatic and extra hepatic bile ducts are unremarkable. Gall bladder appears unremarkable.
CT features of spleen, bilateral kidneys and adrenal glands are unremarkable.
No dilatation or stricture of the small and large bowel loops is seen. Major vessels appear unremarkable.
Case Discussion
The patient has presented with upper abdominal pain which aggravated after taking a fatty meal and denies alcohol consumption.
The patient's serum triglyceride level was very high.
Serum markers were mild raised than normal.
The clinical presentation with current CT findings are concerning for para-duodenal pancreatitis and hepatomegaly with fatty changes as described above.
Co-contributor is Dr, Mohammad Haroon Safi (GI specialitis from Royal Medical Complex).
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