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Woman with history of gallstone pancreatitis.

Our appreciation is extended to Dr. Amit S. Rattan,
Indiana University Department of Radiology,
for contributing this case.

History:  Woman with history of gallstone pancreatitis.
Click for galleryClick for galleryClick for galleryPlease respond to the following with TRUE or FALSE.
There is at least one peripancreatic fluid collection

True or False
There is acute pancreatic necrosis

True or False
There is peripancreatic fat necrosis and post inflammatory change

True or False
There is splenic vein thrombosis

True or False
There are findings compatible with fistulization

True or False
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Woman with history of gallstone pancreatitis.

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Findings:

1.  The pancreas is surrounded by evidence of fat necrosis and post inflammatory change with a fluid collection adjacent to the pancreatic body measuring approximately 1.3 cm x 2.7 cm.

2.  Several linear connections between the stomach and pancreatic fluid collection (see annotation below).

3.  Splenic vein thrombosis.


Differential diagnosis:

  • Post-therapy changes.
  • Pancreatic abscess
  • Pancreatic pseudocyst
  • Disconnected duct syndrome and fistulization
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Woman with history of gallstone pancreatitis.


Key points - Disconnected duct syndrome: 

  • Segment of pancreatic duct disconnected but still viable, with resultant end fistula with uncontrolled leak of secretions into peripancreatic spaces.
  • Diagnostic criteria:
    • Necrosis of minimum 2cm of pancreas and
    • Viable pancreatic tissue upstream and
    • Extravasation of contrast at pancreaticography.
      • Sensitivity of MRCP with secretin less than ERCP.
  • This case demonstrated fistulization to the stomach with resultant secretions entering the stomach and no large peripancreatic collection.

References: 

  1. "Disconnection of the pancreatic duct: An important but overlooked complication of severe acute pancreatitis."
  2. Sandrasegaran, K., Tann, M., Jennings, S., Gregory, Maglinte, D., Peter, S., Sherman, S., Howard, T.
  3. Radiographics 2007; 27:1389-1400  .
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Woman with history of gallstone pancreatitis.


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