Encapsulated necrotic pancreatitis

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Abstract

This study presents a rare clinical case of encapsulated necrotic pancreatitis, which was a complication of acute pancreatitis that arose against the background of alimentary disorders. The aspects of the semiotics of radiation diagnostic methods in the follow-up control of these pathologies were presented.

This case is notable for the manifestation of diseases upon hospital admission, as in the classical edematous form of acute pancreatitis, with a further increase in negative dynamics. This demonstrated the possible stepwise disease development, accompanied by a series of follow-up computed tomography between the clinical and morphological phases of acute pancreatitis and before the formation of pancreatic necrosis, which was complicated by sequestration of the pancreatic body with peripancreatic abscess formation. Afterward, the therapeutic paradigm was changed, and the place of the conservative approach was taken by active surgical tactics, followed by repeated manipulations and follow-up computed tomography and magnetic resonance until the improvement of the patient’s condition.

About the authors

Svetlana I. Kitavina

Therapy and Rehabilitation Center

Email: skitavina@yandex.ru
ORCID iD: 0000-0002-1280-1089
SPIN-code: 9741-1675

MD, Cand. Sci. (Med.)

Russian Federation, 3 Ivan’kovskoe shosse, 125367, Moscow

Victor S. Petrovichev

Therapy and Rehabilitation Center

Email: petrovi4ev@gmail.com
ORCID iD: 0000-0002-8391-2771
SPIN-code: 7730-7420

MD, Cand. Sci. (Med.)

Russian Federation, 3 Ivan’kovskoe shosse, 125367, Moscow

Aleksandr N. Ermakov

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: alx-ermakovv@yandex.ru
ORCID iD: 0000-0003-0675-8624
SPIN-code: 9257-9319

MD

Russian Federation, 3 Ivan’kovskoe shosse, 125367, Moscow

Nikolay A. Ermakov

Therapy and Rehabilitation Center

Email: n-ermakov@yandex.ru
ORCID iD: 0000-0002-1271-7960
SPIN-code: 5985-9032

MD, Cand. Sci. (Med.)

Russian Federation, 3 Ivan’kovskoe shosse, 125367, Moscow

Igor G. Nikitin

Therapy and Rehabilitation Center

Author for correspondence.
Email: igor.nikitin.64@mail.ru
ORCID iD: 0000-0003-1699-0881
SPIN-code: 3595-1990

MD, Dr. Sci. (Med.), Professor

Russian Federation, 3 Ivan’kovskoe shosse, 125367, Moscow

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Supplementary files

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2. Fig. 1. Computed tomography of abdominal organs with intravenous contrast: infiltration of peripancreatic adipose tissue and adipose tissue in the subhepatic space (arrows).

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3. Fig. 2. Computed tomography of abdominal organs with intravenous contrast: infiltration and fluid accumulations in the peripancreatic fatty tissue, along the course of the parotid fascia on the left, in the parenchyma of the head and body of the pancreas (arrows).

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4. Fig. 3. Computed tomography of abdominal organs with intravenous contrast: infiltration and fluid accumulations in the peripancreatic adipose tissue, along the course of the amniotic fascia on the left, in the parenchyma of the head and body of the pancreas (arrows); drainage tube (zigzag arrow in the image on the left). In dynamics, the formation of a thin contrasting capsule along the course of the infiltration zone is noted.

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5. Fig. 4. Computed tomography of the abdominal cavity organs with intravenous contrast: enveloped infiltration and fluid accumulation in the peripancreatic adipose tissue, decreased in dynamics (image on the left, arrows), hemostatic sponge in the cavity of the enveloped contents; drainage tube (image on the right, zigzag arrow). Further formation of a thin contrasting capsule along the course of the infiltration zone is noted in the dynamics.

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6. Fig. 5. Magnetic resonance tomographic cholangiography (left) and T2-VI (coronal plane, right). The distal part of the choledochus is "lost" in the infiltrate, the proximal part of the choledochus and the intrahepatic bile ducts are not dilated (arrows).

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7. Fig. 6. Computed tomography of abdominal organs with intravenous contrast: drainage tube (image on the left, arrow); precipitated infiltration and fluid accumulation in peripancreatic adipose tissue, decreased in dynamics (image on the right, arrow).

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Copyright (c) 2022 Kitavina S.I., Petrovichev V.S., Ermakov A.N., Ermakov N.A., Nikitin I.G.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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