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Resident: Acute Severe Necrotizing Pancreatitis with Recurrent Pseudocyst Formation: A case Report
EP30820
Poster Title: Resident: Acute Severe Necrotizing Pancreatitis with Recurrent Pseudocyst Formation: A case Report
Submitted on 15 Oct 2019
Author(s): Bader Kashlan, DO and Geetanjali Kumar, MD
Affiliations: Piedmont Columbus Regional Family Medicine Residency
Poster Views: 218
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Poster Information
Abstract: 34 year old AAF with PMH of hypertension and bipolar disorder presented to ER with acute onset of abdominal pain, nausea and vomiting that started on that day, never had these symptoms in the past. On admission her urinalysis and urine pregnancy test were negative, her white cell count 15,000, lipase was 14,828, had elevated CRP, lactic acidosis and metabolic acidosis. US showed multiple gallstones without any signs of cholecystitis. CT abdomen showed findings consistent with acute pancreatitis. MRCP was negative for biliary dilation. Patient’s clinical condition continued to worsen. Repeat CT showed severe necrotizing pancreatitis with development of pseudo-pancreatic cyst. Multidisciplinary team was involved in the care of the patient at this point. IR was consulted for percutaneous CT guided drainage of pseudocyst which was done twice. Gen surgery and GI recommended transferring patient to tertiary care center for endoscopic transgastric or surgical debridement with laparoscopic necrosectomy or open necrosectomy and the patient was accepted. However, patient’s condition improved and didn’t require transfer.

Severe pancreatitis has a mortality rate of up to 30%. Initial treatment includes aggressive hydration and close hemodynamic monitoring to prevent morbidity and mortality. Interventional Radiology has an important role to play in the management of local complications of acute pancreatitis, such as necrosis, pseudocyst, and abscess. Severe pancreatitis with infected necrosis or persistent fluid collection should be treated with early percutaneous CT- guided aspiration of fluid or endoscopic transgastric drainage which can decrease length of stay and complication rate
Summary: Acute pancreatitis is an acute inflammatory process, that can be diagnosed clinically, chemically and radiologically. It accounts for more than 200,000 admissions annually. Incidence in the United States ranges from 4.9-35 per 100,000 population. References: Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102.
Quinlan JD. Acute Pancreatitis. American Family Physician. 2014;90(9):632–639.
Worhunsky DJ, Qadan M, Dua MM, Park WG, Poultsides GA, Norton JA, Visser BC. Laparoscopic transgastric necrosectomy for the management of pancreatic necrosis. J Am Coll Surg. 2014;219:735–743.
Seewald S, Ang TL, Teng KC, et al. EUS-guided drainage of pancreatic pseudocysts, abscesses and infected necrosis. Dig Endosc. 2009;21(Suppl 1):S61–5.
Kawakami H, Itoi T, Sakamoto N. Endoscopic Ultrasound-guided transluminal drainage for peripancreatic fluid collections: where are we now?. Gut Liver. 2014;8(4);341-355.doi10.5009/gnl.2014.8.4.341
Byrne MF, Mitchell RM, Baillie J. Pancreatic Pseudocysts. Curr Treat Options Gastroenterol. 2002;5:331–8.
Tiing A, Anthony T. EUS- guided drainage of pancreatic fluid co
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