A 28-year-old woman with a history of infantile cerebral palsy, spastic tetraparesis and vomiting episodes treated with fenobarbital was admitted with a 24-hour history of fever and abdominal discomfort.
Upon arrival to the emergency department the patient was hemodynamically stable, afflicted, thin (BMI 18 kg/m2), highlighting the physical examination marked abdominal distention, predominantly epigastric irritation, without deep signs or pain related to constipation.
A nasogastric tube with abundant outflow of bilious fluid was placed upon suspicion of intestinal obstruction. The following additional tests were performed: abdominal x-ray (6.990 IU), which showed markedly elevated hepatic transaminases < 350 μg/ abnormal, abnormal
These findings suggestive of intestinal subocclusion at the duodenal level, a computerized tomography was performed, which showed a large gastric and duodenal septal defect and pinza axial-mes, with decreased space between them.
Glandular necrosis of the head and tail of pancreas with normal extrahepatic fat and free fluid in both paracolic droplets, compatible with Balthazar grade D; intra- and intrahepatic bile duct.
During admission, the patient was maintained on total parenteral nutrition and nasogastric tube with continuous aspiration, obtaining a output of approximately 2,000 cc of bilious fluid a day.
Blood cultures were negative and fever was self-limiting.
Serial determination of amilasuria showed oscillating values between 1,000-4500 IU/l for approximately 10 days and the clinical picture gradually resolved after 3 weeks.
An abdominal tomography performed before discharge showed resolution of pancreatitis as well as dilation of the gastric chamber and duodenum.
To rule out other possible causes of pancreatitis, abdominal ultrasound was normal and serology for viruses (CMV, EBV, herpes virus, measles, rubella and varicella zoster) was negative.
The patient was discharged home and monitored on an outpatient basis, with good subsequent evolution for 1 year.
