A 77 years old gentleman presented to the Emergency Department of our hospital complaining of ongoing
abdominal pain for 8 h. The patient had clinical features of
pancreatitis with a raised
lipase of 3810 U/L, A computed tomography (CT) abdomen confirmed
pancreatitis with extensive peri-pancreatic
edema. During the course of his admission, the patient had persistent high
fevers and
delirium thought secondary to infected
necrosis, prompting the commencement of broad-spectrum
antibiotic therapy with
Piperacillin/Tazobactam. Subsequent CT abdomen confirmed extensive
pancreatic necrosis (over 70%). Patient was managed with supportive
therapy,
nutritional support and gut rest initially and improved over the course of his admission and was discharged 42 d post admission. He represented 24 d following his discharge with
fever and
chills and a repeat CT abdomen scan noted gas bubbles within the necrotic pancreatic tissue thereby confirming infected necrotic
pancreatitis. This CT scan also revealed asymmetric thickening of the rectal wall suspicious for
malignancy. A
rectal cancer was confirmed on flexible sigmoidoscopy. The patient underwent two endoscopic necrosectomies and was treated with intravenous
antibiotics and was discharged after 28 d. Within 1 wk post discharge, the patient commenced a course of
neoadjuvant radiotherapy and subsequently underwent concomitant
chemotherapy prior to undergoing a successful Hartmann's procedure for treatment of his
colorectal cancer.
CONCLUSION: