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Answers on p 672.
An 81 year old woman presented, as an emergency, with a two day history of abdominal pain. The pain was intermittent and confined to the right upper quadrant. She had no other symptoms and normally enjoyed good health. Examination revealed tenderness in the right hypochondrium. Investigations revealed a mildly raised serum alkaline phosphatase. All other haematological and biochemical parameters were within normal limits. A provisional diagnosis of biliary colic was made.
Four days later, the patient experienced diarrhoea and vomiting. Her abdominal pain had increased and there was generalised abdominal tenderness. She developed a pyrexia of 38°C. An ultrasound scan demonstrated a distended gall bladder with stones and a dilated common bile duct (12.6 mm). Antibiotic treatment was started. The patient made little progress with continued diarrhoea and vomiting. Stool cultures and sigmoidoscopy were normal. Parenteral nutrition was started.
Over the next two days, the patient developed a palpable mass in the epigastrium. Repeat ultrasound showed a normal biliary tree, but a mass consistent with a necrotic pancreas with pseudocyst was imaged. Computed tomography of the abdomen and pelvis was requested. Computed tomograms are shown in figs 1 and2.
- The images show a characteristic mass lesion anteriorly. What diagnosis is suggested by these findings?
- How may this condition present in adults?
- How should such cases be managed?