Title: 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.

Biography:

Dr. Avneet Kaur is a general surgery postgraduate resident at VMMC and Safdarjang Hospital, New Delhi. She has an avid interest in the research and enthusiastic about surgical oncology. She is curious about the unusual presentations of the diseases and has been an active member of the conferences organized by the institution.