We report the case of a 60-year-old man with a history of recurrent mild acute biliary pancreatitis admitted for a new episode of probable biliary origin.
The patient was transferred to the Intensive Care Unit after eight days of worsening with renal failure lactate binding leukocytes 19.940/mm3, metabolic acidosis (pH 7.3; base excess -4 mmol/l; bicarbonate 21.6 mmol/dl).
CT scan performed seven days later revealed necrotizing pancreatitis with multiple extrapancreatic features, which led to percutaneous drainage of the larger collection, with a torpid evolution (AU)
Progressive worsening occurs, and the patient has multiple organ failure and hemodynamic instability (hemoglobin 6.8 mg/dl, pH 7.1, lactate 13.2 mmol/l) and sustained intra-abdominal pressure of 21-22 mmHg.
Emergency CT is performed, showing extensive pancreatic necrosis and acute hemorrhagic foci of epiplons that cause great gastric and hepatic compression with visceral infarction.
Emergency laparotomy was performed with evacuation of a large expansive hematoma and wide necrosectomy, including almost the entire pancreatic gland.
Septic shock and refractory multiorgan failure occur.
The patient died 20 days after admission.
