title: [A quite usual pancreatitis?].
abstract: METHODS
  A 55-year-old man suffered from severe acute abdominal pain. 10 years previously he had been diagnosed with acute pancreatitis. On palpation, there was pronounced abdominal tenderness and guarding.
  
  
  METHODS
  Emergency CT revealed signs of intra- and extrahepatic cholestasis and biliar sludge; serum-lipase was increased.
  
  
  METHODS
  Acute biliary pancreatitis was diagnosed. After admission the patient's condition deteriorated; acute renal failure and respiratory insufficiency developed. After 4 weeks of intensive care he was discharged to a rehabilitation facility via normal ward. At that time pancreatic sonography showed a walled-off necrosis. 7 weeks later colicky abdominal pain occurred again. Altough there were no signs of infection, suction-irrigation drainage was administered. This led to a secondary infection of the necrotic cavity, and 20 sessions of endoscopic necrosectomy were performed for 3 month. Then the patient was discharged to follow-up treatment in a stable condition.
  
  
  CONCLUSIONS
  Even in supposedly "usual" acute pancreatitis complications can lead to a prolonged course. Sterile necroses should be managed very cautiously.
authors.affiliation: Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, AöR. juergen.feisthammel@medizin.uni-leipzig.de
authors.forename: J
authors.initials: J
authors.lastname: Feisthammel
authors.forename: J
authors.initials: J
authors.lastname: Mössner
authors.forename: A
authors.initials: A
authors.lastname: Hoffmeister
mesh_terms: D001651:Cholestasis, Extrahepatic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D003422:Critical Care; D018450:Disease Progression; D004630:Emergencies; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography