A case of severe acute pancreatitis

Ken-ichi Mukaisho 1, Hiroyuki Sugihara 1, Yuki Yagi 2, Takuzo Nannbu 2, Masahiro Yamamoto 3, Toshiyuki Tsujioka 3

1 Department of Pathology, Shiga University of Medical Science
2 Department of Internal Medicine, Kohka Public Hospital
3 Department of Central Clinical Laboratory, Kohka Public Hospital

  We report on a clinico-pathological conference of an autopsy case of a male in his late sixties who from severe acute pancreatitis. He was admitted to another hospital because of epigastralgia, and diagnosed as having an acute pancreatitis. He was transferred to our hospital after 4 days of non-surgical treatment. In his past history, he underwent a gastrectomy with Billroth-II reconstruction 40 years ago because of a gastric ulcer, and cholecystectomy 3 years ago due to gallstones. On the 46th day after onset, he died due to a hard to control infection (Candida and MRSA etc) in addition to the acute pancreatitis. An autopsy revealed necrotizing pancreatitis with pancreatic pseudocysts accompanied by multisystem organ failure due to sepsis and ARDS. The cause of the pancreatitis was a gallstone in the common bile duct. We reappraised the clinical management of the case, nothing the difficulty of carrying out endoscopic retrograde cholangiography due to the Billroth-II reconstruction and referring to the optimal timing of drainage of pancreatic pseudocysts, and the possible application of continuous arterial infusion of protease inhibitor and antibiotics.

Key word : CPC, acute pancreatitis, gallstone, drainage, continuous arterial infusion