A Case of Painless Severe Acute Pancreatitis

Masahiro Kamiga¹⁾, Kiyoshi Sato, Yasuhiko Midorikawa, Minoru Hanada*, Yukio Kubota*

Department of Surgery and Internal Medicine*, Kureha General Hospital
¹⁾First Department of Surgery, Yamagata University School of Medicine

A case of severe, acute pancreatitis without any associated pain during the clinical course is reported. The patient, a 45-year-old man, was admitted to our hospital with chief complaints of nausea, vomiting and jaundice. Based on the results of hematological and blood chemical analyses and abdominal CT, a diagnosis of severe, acute pancreatitis was made. However, he reported no abdominal pain at all at the onset or after hospital admission. Immediately after admission, the patient was placed under strict systematic care while being treated with proteolytic enzyme inhibitors and continuous hemodialysis. In spite of this intensive conservative therapy, the platelet decreased suddenly, the patient gradually showed a tendency toward DIC and suspected the infection of pancreatic tissue, he was underwent surgery on the 10th day. The pancreas was almost entirely necrotic, and the pathologic process spread extensively to the retroperitoneal space. The necrotic tissue was excised as much as possible. During the postoperative period, the patient developed MRSA pneumonia and a peritoneal abscess, which made recovery difficult. After a slow and gradual recovery, he was discharged on the 105th postoperative day. This patient lacked the abdominal pain that develops in almost all cases of acute pancreatitis, thus delaying early diagnosis and treatment. Such delays may result in a poor outcome, so clinicians should be alerted to these atypical cases.

Key words
painless acute pancreatitis

Reprint requests
Masahiro Kamiga First Department of Surgery, Yamagata University School of Medicine
2-2-2 Iidanishi, Yamagata, 990-23 JAPAN

Accepted
October 11, 1995

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