CASE 262: BIG ABDOMEN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Man 50 yo, one week ago, onset periumbilical pain and abdominal distension, no defecation nor fever.

Chest Xray, and  abdomen standing  plain film showed  the  water-air level in  intestine, suggesting  bowel obstruction.

Ultrasound  found out colon dilatation, filling water and moving circular around with hyperperistalsis (see video).

MSCT of  abdomen in  emergency detected dilated right colon and  small intestine, retroperitoneum edema  arround the pancreas and radiologist  suggested  that pancreatitis.

Blood test: WBC  rising 12k, amylasemia normal.
Operation  laparotomy detected  all  bowel in dilatation but  no  necrosis, no tumor obstruction. 
Many white spots like candle   intra peritoneum.
Retroperitoneal space edema. Surgeon said chronic pancreatitis.

Discussion of this case:  clinical findings were abdominal pain and distension for one week. XRay  and  ultrasound found out  bowel obstruction and CT  detected  pancreatitis, but  blood test amylasemia was 17 unit.

Surgeon decided operation by bowel obstruction.
Now  report  is  chronic pancreatitis, it is  a rare  case with normal amylasemia in acute  pancreatitis.

REFERENCE:  case report