S1471 Deadly Abdominal Pain: Hemorrhagic Necrotizing Pancreatitis

Abstract

INTRODUCTION: In the United States the overall mortality in acute pancreatitis is approximately 5%. In patients that develop complications, such as necrotizing pancreatitis, mortality can increase up to 30% and in those who develop hemorrhagic pancreatitis mortality can reach 86% within 7 days. Prompt diagnosis and treatment is imperative to decrease associated mortality. CASE DESCRIPTION/METHODS: This is a 56-year-old man with a medical history of hypertension that was brought to ED after 10 hours of evolution of sudden burning epigastric abdominal pain. At the moment of evaluation patient was found diaphoretic, uncomfortable, and oliguric, but remained talkative and cooperative. Initial abdominal ultrasound revealed a 9 mm calculus that moved freely along the dependent portion of a normally distended gallbladder without dilation of the common bile duct. Laboratory showed leukocytosis of 22.4 cells/10-3 uL, Lipase >18,000, transaminitis, and worsening renal function. He was diagnosed with acute pancreatitis and started on aggressive fluid resuscitation. Rapid clinical deterioration requiring mechanical ventilation, vasopressors, hemodialysis and intensive care unit admission were required. Computerized tomography demonstrated multiple air lobes within the peritoneum, concerning for infected pancreatitis versus fistulous connection at adjacent bowel. Intravenous antibiotics were started, and surgical intervention was considered. Subsequently he developed Fox and Grey-Turner signs both highly suggestive of hemorrhagic pancreatitis. He unfortunately passed away within 28 hours of arrival despite aggressive treatment. Although most common after 4 weeks, this is a rare case of walled off necrotizing pancreatitis that occurred in the acute phase of the disease that transformed into hemorrhagic pancreatitis with rapid deterioration. DISCUSSION: This case illustrates the catastrophic potential complications of acute pancreatitis in a healthy patient. Prompt identification of possible complications related to acute pancreatitis is essential to ensure early aggressive treatment and improve disease outcomes.Figure 1.: Abdominal CT without contrast enhancement with multiple air locules suggestive of Infected pancreatitis.Figure 2.: Fox's Sign.Figure 3.: Grey-Turner's sign.