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Case Reports
. 2023 Aug 7;15(8):e43075.
doi: 10.7759/cureus.43075. eCollection 2023 Aug.

Necrotising Inflammation of Peri-Pancreatic Tissue With Normal Appearance of Pancreas Is a Distinct Entity of Acute Pancreatitis: Report of Two Cases With Review of Literature

Pagadala Nitesh  1 , Pottakkat Biju  1 , Raja Kalayarasan  1 , Pothugunta S Krishna  1
Affiliations
Case Reports

Necrotising Inflammation of Peri-Pancreatic Tissue With Normal Appearance of Pancreas Is a Distinct Entity of Acute Pancreatitis: Report of Two Cases With Review of Literature

Pagadala Nitesh et al. Cureus. .

Abstract

Improved insights into the pathophysiology of acute pancreatitis have paved the way for identification of distinct entities in the spectrum of the disease. The presence of necrotising inflammation limited to peripancreatic tissue with a normal appearance of pancreas is one such entity. This entity, described as extrapancreatic necrotising pancreatitis (EPN), is considered a less aggressive form of acute necrotising pancreatitis. This entity needs to be recognized precisely and managed accordingly among patients with acute pancreatitis. However, EPN has not been highlighted in the revised classification of acute pancreatitis. Here we report two patients with EPN with varied presentations and diverse management and outcome.

Keywords: acute pancreatitis; extrapancreatic necrotising pancreatitis; necrotising pancreatitis; peri-pancreatic inflammation; revised atlanta’s classification.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A: Contrast-enhanced computed tomography (CECT) image of patient in Case 1 showing normal enhancement of entire pancreas with preserved lobularity of the gland (black arrow). B: In the processed image of patient in Case 1, preserved layer of anterior pancreatic capsule is depicted in green colour (black arrow) highlighting the intactness of pancreas in extrapancreatic necrotising pancreatitis.
Figure 2
Figure 2. Contrast-enhanced computed tomography (CECT) image of patient in Case 1 demonstrating collection with air pockets (black arrow) adjacent to normally enhancing head of pancreas (green arrow).
Figure 3
Figure 3. Contrast-enhanced computed tomography (CECT) abdomen showing normal pancreas (blue arrow) at six-month follow-up.
Figure 4
Figure 4. Non-contrast computed tomography (NCCT) of abdomen revealing 14 X 10 X 8 cm heterogenous collection in lesser sac with air pockets.
Figure 5
Figure 5. Intraoperative image showing preserved pancreas (black arrow) with necrotic flakes over the surface alone.
See this image and copyright information in PMC

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