Constellation of rare complications following acute pancreatitis- a case report
Abstract
Acute pancreatitis is characterised by inflammation of
pancreas which can be of varying severity depending on
the local and systemic complications. An enterovesical fistula
is an extremely rare complication of necrotising pancreatitis.
Pseudoaneurysms are another rare set of complications
associated with pancreatitis that can occur due
to the pancratic enzymes eroding the surrounding planes.
This case involves the simultaneous presence of these uncommon
conditions in a single patient. A chronic alcoholic
patient presented to the ED with pain in left lumbar
region associated with obstipation, bilious vomiting and
fever. A CT scan of abdomen was done which reported
necrotic area within body and tail of pancreas involving
less than 30% area with multiple hypodense peripherally
enhancing collections in anterior pararenal space along
with left paracolic gutter and left supramesocolic space.
Another collection was seen in superior to dome of bladder
with adjacent clumped distal jejunal loops which
showed extravasation of oral contrast in the collection.
The collection communicated with the bladder with a
tract that measured 15.5 mm, suggestive of an enterovesical
fistula. The patient was managed conservatively with
TPN and an ultrasound guided pigtail catheterization
of suprapubic collection to control the intra- abdominal
collection. The output through the pigtail catheterization
gradually decreased and the urine output became clearer.
The patient developed two episodes of hematemesis. It
was decided to proceed with a CT angiography that revealed
a wide necked splenic artery pseudoaneurysm with
no extravasation. Urgent coil embolization of the artery
was done. Patient is now doing well.
