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Program

Internal Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Hospital

Abstract

Introduction: Acute pancreatitis is a common disease characterized by release and activation of proteolytic enzymes which lead to nonspecific inflammation of the pancreas and surrounding tissue. Inflammation can spread to nearby retroperitoneal organs like the kidneys and spleen. Renal involvement can range from acute kidney injury, perirenal fat stranding with perirenal fluid collection to renal vein thrombosis and parenchymal abnormalities. Case Description: 68 years old male with past medical history significant for type 2 diabetes mellitus and bladder cancer s/p cystectomy with ileal conduit presented with acute onset peri-umbilical abdominal pain and vomiting. He was found to be in diabetic ketoacidosis (DKA) and had an elevated lipase. Abdominal CT without contrast showed a complex cystic mass associated with the pancreatic tail that drapes over the upper pole and anterior margin of the mid left kidney with stranding and haziness in the adjacent fat. CA 19-9 was elevated. Working diagnosis was acute pancreatitis and patient was treatment with aggressive fluid resuscitation. MRCP showed parenchymal changes within the left kidney with multiple perinephric loculations and complex collections, partially encasing the left kidney and extending superiorly to the tail of the pancreas. Findings were concerning for pyelonephritis and peri-nephric abscess therefore urology were consulted. Findings were attributed to acute pancreatitis with spread of inflammation to the left kidney. Patient’s symptoms improved and he was discharged home with repeat imaging in 2 weeks. Repeat imaging showed resolving inflammation and no underlying masses. Discussion: This case necessitated involvement of different specialties to determine whether the findings were due to renal process as opposed to a pancreatic process. Patient had complex urological anatomy after his cystectomy with ileal conduit which predisposed him to pyelonephritis. However, patient symptoms improved after conservative management. He was afebrile and did not develop any leukocytosis. Attempts to drain the fluid collection around the kidneys might predispose the patient to fistula formation. It is very important to know that renal and perirenal involvement is a common finding in acute pancreatitis. A study showed that perirenal fat stranding was found in 62% of patients with acute pancreatitis and 40% had perirenal fluid collection. Conclusion: Understanding that renal and peri-renal involvement is a common finding in acute pancreatitis can prevent unnecessary investigations and interventions.

Publication Date

5-2019

Peri-renal and Renal Involvement in Acute Pancreatitis

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