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[A quite usual pancreatitis?].

HISTORY AND CLINICAL FINDINGS
A 55-year-old man suffered from severe acute abdominal pain. 10 years previously he had been diagnosed with acute pancreatitis. On palpation, there was pronounced abdominal tenderness and guarding.


INVESTIGATIONS
Emergency CT revealed signs of intra- and extrahepatic cholestasis and biliar sludge; serum-lipase was increased.


TREATMENT AND COURSE
Acute biliary pancreatitis was diagnosed. After admission the patient's condition deteriorated; acute renal failure and respiratory insufficiency developed. After 4 weeks of intensive care he was discharged to a rehabilitation facility via normal ward. At that time pancreatic sonography showed a walled-off necrosis. 7 weeks later colicky abdominal pain occurred again. Altough there were no signs of infection, suction-irrigation drainage was administered. This led to a secondary infection of the necrotic cavity, and 20 sessions of endoscopic necrosectomy were performed for 3 month. Then the patient was discharged to follow-up treatment in a stable condition.


CONCLUSION
Even in supposedly "usual" acute pancreatitis complications can lead to a prolonged course. Sterile necroses should be managed very cautiously.