Acute necrotising pancreatitis masquerading as psoas abscess: A report of two cases

Main Article Content

Praveenkumar M Patil
Kartik Sharma
Navneet Kaur

Abstract

Acute pancreatitis is commonly diagnosed clinically, with its classical presentation of upper abdominal pain, backed by raised serum levels of enzymes amylase and lipase. However, unusual presentation of this common surgical emergency as a psoas abscess is a rare finding which can lead to missed diagnosis with a fatal outcome.


We present here two such cases of acute necrotising pancreatitis masquerading as psoas abscess, with no classical clinical symptoms and only mildly raised levels of serum amylase and lipase. The region of pancreas involved by necrosis influenced the site of presentation of the psoas abscess. In the first case, acute necrotising pancreatitis involving head and neck of pancreas presented as psoas abscess presenting in the right lumbar region, while the left side collection due to pancreatitis involving body and tail of pancreas manifested as an abscess in left flank.


While evaluating the aetiology of a psoas abscess, a differential diagnosis of necrotizing pancreatitis should be kept as a possibility.

Article Details

M Patil, P., Sharma, K., & Kaur, N. (2020). Acute necrotising pancreatitis masquerading as psoas abscess: A report of two cases. Archives of Surgery and Clinical Research, 4(2), 018–021. https://doi.org/10.29328/journal.ascr.1001046
Case Reports

Copyright (c) 2020 Patil PM, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Nadhem O, Salh O. Acute pancreatitis: an atypical presentation. Case Rep Gastroenterol. 2017; 11: 359-363. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471751/

Jain VK, Hadiyal A, Jolly S. Unusual presentation of pancreatic pseudocyst as a psoas abscess. International Surgery Journal. 2019; 6: 1395-1399.

Moens L, YengueYengue P, Assenmacher C. Intrascrotal collection in an acute pancreatitis: a case report and review of the literature. Case Rep Urol. 2016; 2016. 7534781. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27882260

Kamble PM, Patil A, Jadhav S, Rao SA. Anterior abdominal wall abscess with epididymo-orchitis: An unusual presentation of acute pancreatitis. J Postgrad Med. 2011; 57: 335-337. PubMed: https://pubmed.ncbi.nlm.nih.gov/22120865/

Tyberg A, Karia K, Gabr M, Desai A, Doshi R, Gaidhane M, Sharaiha RZ, Kahaleh M. Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol. 2016; 22: 2256-2270. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735000/

Zhao K, Adam SZ, Keswani RN, Horowitz JM, Miller FH. Acute pancreatitis: revised Atlanta classification and the role of cross-sectional imaging. AJR Am J Roentgenol. 2015; 205: W32-41. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26102416

Palanati V, Santhosh Anand KS, Thirunavukkarasu S, Munikrishna S, Reddy S, et al. Psoas Abscess-An Unusual Presentation of WOPN. World J Surgical Res. 2018; 1: 1083.

Working GI, APA AP. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013; 13(4 Suppl 2): e1-15. PubMed: https://pubmed.ncbi.nlm.nih.gov/24054878/

Besselink MG, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, et al. Minimally invasive ‘step-up approach’versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006; 6: 6. PubMed: https://pubmed.ncbi.nlm.nih.gov/16606471/

Kumar N, Conwell DL, Thompson CC. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas. 2014; 43: 1334-1339. PubMed: https://pubmed.ncbi.nlm.nih.gov/25083997