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BMJ Case Reports 2012; doi:10.1136/bcr.11.2011.5255
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Acute pancreatitis with pancreatic abscess secondary to sealed jejunal diverticular perforation

  1. Philip Shorvon3
  1. 1Academic Anaesthetics, Chelsea and Westminster Hospital, London, UK
  2. 2Surgery Department, St Thomas’ Hospital, London, UK
  3. 3Radiology Department, Northwest London Hospitals NHS trust, London, UK
  1. Correspondence to Dr Angela King, angelaking{at}doctors.org.uk

Summary

Although most cases of acute pancreatitis are attributed to gallstones or alcohol, many remain idiopathic. The authors describe a case of acute pancreatitis in a 75-year-old gentleman who presented with acute epigastric pain, fevers and shortness of breath. Serum amylase was 2164. CT showed free mesenteric air, and a partly cystic/partly gas-containing mass in the uncinate lobe of the pancreas. Gastrograffin meal revealed duodenal and jejunal diverticular disease, but no contrast leak. Further CT analysis pinpointed fine tracts of air leading from a jejunal diverticulum up toward the pancreas, suggesting causation by a sealed jejunal diverticular perforation. He responded well to intravenous antibiotics and conservative management. Although small bowel diverticular disease is linked to chronic pancreatitis, evidence for association with acute pancreatitis is scarce. The authors believe this is the first reported case of jejunal diverticular disease causing acute pancreatitis, and it highlights micro-perforation as a potential disease mechanism.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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