Acute on chronic pancreatitis in a young female

A 32-year-old lady presented with complaints of severe pain abdomen and low-grade fever for the past 10 days. She was a known case of chronic calcific pancreatitis since four years and was on pancreatic enzyme replacement therapy. There was no history of alcohol abuse or any chronic medication. Patient had recurrent episodes of pain abdomen, which were managed with non-opioid analgesics. This time she presented with severe pain abdomen and fever. Blood investigations showed leukocytosis and elevated amylase and lipase levels. Abdominal X-ray was done to rule out any acute pathology that revealed large calcifications along the pancreatic region (Panel A). In view of high-grade fever, intravenous antibiotic (Imipenem, 1 g TDS) was started, however fever persisted after 48-hours of therapy. CT scan was done which showed calcific pancreatitis along with peripancreatic and pelvic collections (Panels B,C). Percutaneous drainage of peripancreatic collection was done following which her condition rapidly improved.

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