Severe Acute Pancreatitis Presenting As Appendicular PerforationAn Unusual presentation

Abstract

Pancreatic & Peripancreatic fluid collection is a common complication of severe Acute Pancreatitis. But rarely it can lead to collections at remote sites in peritoneal, retroperitoneal, mediastinal or inguinoscrotal region and manifesting rare presentations. Here is a case of a non alcoholic, non diabetic male, presented with abdominal pain, localized at right iliac fossa with rebound tenderness & features of peritonism. Ultrasonography of abdomen & pelvis shows moderate pelvic collection with internal echos & probe tenderness at right iliac fossa. Patient was diagnosed as a case of Appendicular perforation. On Laparotomy the case was diagnosed as severe acute pancreatitis with secondary/ reactionary appendicitis with pancreatic ascitis, peri pancreatic & pancreatic parenchymal necrosis & pelvic retroperitoneal collection in right iliac fossa extending to the base of appendix. The patient was managed with appendicectomy, draining of pelvic & retroperitoneal pelvic collection, debridement of necrotic fissure in pelvis in right iliac fossa towards right psoas muscle, debridement of patchy necrotic tissue over small bowel mesentery. Thorough irrigation, lavage & suctioning of necrotic & slaughed area on pancreas & peripancreatic tissue had also been done.