Getting the Dead Out: Modern Treatment Strategies for Necrotizing Pancreatitis

Excerpt

A 21-year-old male was brought to the emergency department with severe abdominal pain and vomiting. Low-grade fever and epigastric tenderness were noted on examination; laboratory values included a WBC of 11 K/μL and elevated amylase and lipase to 1,593 and >3,000 U/L, respectively. A CT scan was interpreted as showing an enlarged and ill-defined pancreas with heterogeneous parenchymal enhancement, consistent with pancreatitis. Several peripancreatic fluid collections extended bilaterally to the para-renal spaces, left para-colic gutter, and pelvis (Fig. 1). An ultrasound of the gallbladder was normal with no gallstones visualized. The patient had no other contributory past medical or social history. He was admitted to the medical service and initially developed a systemic inflammatory response (SIRS) to his idiopathic pancreatitis, with fever, tachycardia, and a white count peak to 16 K/μL. After several days of intravenous fluid resuscitation and bowel rest, he improved and was discharged home 10 days later tolerating a regular diet.

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