November 12, 2014
Notes: Fan, Heng
Ren Fail. 2013;35(10):1330-3. doi: 10.3109/0886022X.2013.828187. Epub 2013 Aug 21.
Author Address: Department of Intensive Care Unit, Ningbo First Hospital , Ningbo , China .
Reference Type: Journal Article
Record Number: 4986Author: Feisthammel, J., Mossner, J. and Hoffmeister, A.
Title: [A quite usual pancreatitis?]
Journal: Dtsch Med Wochenschr
Short Title: [A quite usual pancreatitis?]
Alternate Journal: Deutsche medizinische Wochenschrift
ISSN: 1439-4413 (Electronic)
Original Publication: Eine ganz normale Pankreatitis?
Accession Number: 24002875
Keywords: Cholestasis, Extrahepatic/*complications/diagnosis/therapy
Combined Modality Therapy
Pancreatitis, Acute Necrotizing/*diagnosis/*therapy
*Tomography, X-Ray Computed
Abstract: HISTORY AND CLINICAL FINDINGS: A 55-year-old man suffered from severe acute abdominal pain. 10 years previously he had been diagnosed with acute pancreatitis. On palpation, there was pronounced abdominal tenderness and guarding. INVESTIGATIONS: Emergency CT revealed signs of intra- and extrahepatic cholestasis and biliar sludge; serum-lipase was increased. TREATMENT AND COURSE: Acute biliary pancreatitis was diagnosed. After admission the patient’s condition deteriorated; acute renal failure and respiratory insufficiency developed. After 4 weeks of intensive care he was discharged to a rehabilitation facility via normal ward. At that time pancreatic sonography showed a walled-off necrosis. 7 weeks later colicky abdominal pain occurred again. Altough there were no signs of infection, suction-irrigation drainage was administered. This led to a secondary infection of the necrotic cavity, and 20 sessions of endoscopic necrosectomy were performed for 3 month. Then the patient was discharged to follow-up treatment in a stable condition. CONCLUSION: Even in supposedly “usual” acute pancreatitis complications can lead to a prolonged course. Sterile necroses should be managed very cautiously.