A 46-year-old male smoker with an alcohol dependence disorder, who three years before had presented acute pancreatitis of alcoholic etiology.
She came to the emergency department with vomiting in coffee grounds and melenas, without abdominal pain.
The patient had a blood pressure of 90/60, and was afflicted with it.
Cardiorespiratory examination revealed a heart rate of 120 bpm, with no other abnormalities.
The abdomen was depressible, non-painful, and there was thickening of four layers of fingers.
There were no hepatomegaly or peripheral adenopathies.
An analytical study showed the following findings: hemoglobin 10 g/dL, MCV 85 fL, leukocytes 4.4 x109/L, platelets 64 x109/L. Coagulation and hepatic and renal biochemistry showed no abnormalities.
The electrocardiogram showed sinus tachycardia at 120 bpm, with no other abnormalities.
Chest and abdominal X-rays were normal.
A fibrogastroscopy revealed the presence of a congestive area in the gastric body and antrum.
Abdominal ultrasound showed an enlarged spleen of 18 cm, which was confirmed by abdominal computed tomography (CT).
In addition, CT showed a heterogeneous retroperitoneum mass encompassing the head and body of the pancreas, which led to thrombosis of the splenic vein.
A CT-guided needle aspiration biopsy (FNAB) of the mass was performed to rule out possible adenocarcinoma.
In the anatomopathological analysis of this material, there were no atypical cells.
Forty-eight hours after the puncture, the patient developed deaf abdominal pain located in the epigastrium, together with nausea and vomiting.
Blood tests revealed a serum amylase of 312 IU/L (normal < 53 IU/L).
The blood count showed no changes and the rest of the biochemical analyses, including transaminases, were normal.
Abdominal CT was repeated, which showed no large variations, except for the formation of a well-defined lesion in the pancreatic tail of 5 x 2 cm diameter compatible with a pancreatic pseudocyst.
Treatment was established with absolute diet and serum therapy.
After a few days, an abdominal magnetic resonance imaging (MRI) was performed to better define the characteristics of the pancreatic lesion.
The pancreatic gland showed a dilated Wirsung duct and alterations suggestive of chronic pancreatitis.
In addition, the presence of a pancreatic tail pseudocyst was confirmed and another cystic lesion in the left liver lobe of 6 x 6.5 cm in diameter was visualized.
These findings interpreted that the mass detected in the previous CT scan corresponded to edematous pancreas peripancreatic exudates, which had evolved into peripancreatic pseudocysts.
All this was compatible with acute alcoholic chronic pancreatitis.
At that time, enteral nutrition was started using a nasojejunal tube.
An abdominal CT was repeated 14 days later, which showed almost resolution of the hepatic pseudocyst and disappearance of the pseudocyst in the pancreatic tail.
Enteral nutrition was suspended, oral diet was administered, and the patient was discharged asymptomatic.
