26 Acute Necrotizing Pancreatitis

Clinical Presentation

A 68-year-old man presents with vomiting and epigastric pain.

Fig. 26.1 (A–C) Images from a contrast-enhanced abdominal CT scan reveal massive fluid collections extending in the abdomen along the anterior aspect of the liver, in the mesentery, and in the anterior pararenal fasciae. The pancreatic parenchyma shows no enhancement and is almost completely replaced by ill-defined fluid collections. Diffuse mesenteric and peripancreatic fat stranding consistent with inflammatory changes is also noted.

Radiologic Findings

Abdominal contrast-enhanced computed tomography (CT) scan (Fig. 26.1) shows diffuse inflammatory changes in the peripancreatic region, seen as peripancreatic and mesenteric fat stranding, extensive peripancreatic and perihepatic fluid collection, and absence of enhancement within the pancreatic head, neck, and body.