An 83-year-old male with a history of hypertension, hyperuricemia, chronic obstructive pulmonary disease, esophageal diverticulum of the middle third, gastrointestinal bleeding due to duodenal ulcus, ischemic stroke with continuous anticoagulant therapy for right upper atrial fibrillation.
Physical examination revealed arrhythmic pulse, snoring at the lung bases, and tender abdomen due to deep fixation.
Blood tests at admission were: urine leukocyte count 3,830,000; hemoglobin 121 g/l; hematocrite-7m; leukocyte count 14.5 x 109/l with 90% neutrophilia; creatinine 1.83 mg/dl; sediment urea 7DH
Abdominal ultrasound showed enlargement of the pancreatic body and gallstones.
A paulatine increase in blood amylase was observed for seven days up to 1,476 U/l. A computed tomography scan of the abdomen was performed, which showed an enlarged pancreatic duct 5 cm.
Three days later endoscopic retrograde cholangiopancreatography was performed, showing papillary stenosis and bile mud in the common bile duct, performing sphincterotomy.
Twenty-four hours after sphincterotomy, the patient complained of lumbar fossa pain and left sided pain radiating to the left shoulder. The patient persisted with increased analgesic treatment, but a new axial pleural effusion was observed.
Forty days after admission, the patient suffered an episode of diffuse abdominal pain accompanied by profuse sweating, tachypnea, tachycardia and hypotension.
The examination revealed abdominal discoloration, tympanism, absence oftalsis, and presence of black feces in the rectal examination, with ischemia month.
Exitus 12 hours after the episode.
