History: 61 yo male with h/o pancreatitis and worsening abdominal pain.
Solution: The plain film findings in this case include reticular decreased density over the pancreatic bed. Follow up CT identified impressive air within the pancreatic bed in the setting of necrotic pancreatitis.
The differential is necrotic pancreatitis and abscess formation (which should be the primary consideration), and spontaneous development of a enteric fistula. This patient was not septic and in fact overall, was thought to be improving, which can occur when fistula develop. Note that if this was in fact an abscess, the expected mortality rate would be 25-70%. However, this patient continued to do well and improve, suggesting that this was not an abscess. Knowing about this entity can avoid rapid unnecessary intervention/surgery.
The differential is necrotic pancreatitis and abscess formation (which should be the primary consideration), and spontaneous development of a enteric fistula. This patient was not septic and in fact overall, was thought to be improving, which can occur when fistula develop. Note that if this was in fact an abscess, the expected mortality rate would be 25-70%. However, this patient continued to do well and improve, suggesting that this was not an abscess. Knowing about this entity can avoid rapid unnecessary intervention/surgery.
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