Patient is a 40 year male patient, with h/o alcohol consumption 2 days back, presented with acute epigastric pain, and raised serum amylase. Non-contrast CT images showed features of acute pancreatitis with hyperdense attenuation in the peripancreatic region, superior to the distal D3 (horizontal) segment of duodenum.
Extravasated pancreatic enzymes are usually responsible for the capillary and venule disruption, which leads to hemorrhage. Bleeding is usually self limited, but marked hemorrhage can occur in 2-5% of cases.
Non-contrast images show fatty infiltration of liver (30-35HU).
Contrast images showed no enhancement of the hyperdense area.
Incidentally there was also Pancreas Divisum. There was no connection with the larger dorsal duct (Duct of Santorini) and the smaller ventral duct (Duct of Wirsung). Dorsal duct drained into the minor papilla and ventral duct, joined the distal CBD and drained into the duodenum through the major papilla. Pancreas divisum may be seen in upto 10% of general population. The relationship of PD with Pancreatitis remains controversial.
DIAGNOSIS : Acute hemorrhagic pancreatitis with Pancreas Divisum.
Incidentally the patient had a right distal ureteric calculus close to the VUJ, which he was not symptomatic of, at the time.
Reference : 'The Bloody Pancreas', AJR,2009.
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