Acute epigastric pain associated with vomiting with a history of recently managed paraduodenal abscess.
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The pancreas appears swollen but does enhance uniformly and there is significant edema in the peripancreatic and perigastric region, severe in the head and neck region of the pancreas accompanied by small surrounding fluid collection in the peripancreatic region with significant fat stranding in the perigastric and peripancreatic regions as well as the mesentery, along with thickened duodenal wall with no duodenal stenosis.
The free fluid is seen tracking to a collection within the right paracolic gutter. There are multiple reactive regional lymphadenopathies.
Enlarged diffuse fatty liver is also noted.
The patient underwent conservative treatment for a paraduodenal abscess with an oral antibiotic for 3 weeks and stop treatment for 2 weeks then admitted again with acute abdominal pain.
The laboratory evaluation of our case was done on ER showing elevated pancreatic enzymes as lipase was 1211 U/L (normal up to 330 U/L) and amylase 158 U/L (normal up to 110 U/L) that confirm the diagnosis of acute pancreatitis.
Paraduodenal pancreatitis is an inflammatory process of the groove area between the duodenal wall and the pancreatic head.
The patient history of the paraduodenal abscess along with CT findings and laboratory results are highly suggestive of segmental paraduodenal pancreatitis.