The value of computed tomography in the diagnosis of acute necrotising pancreatitis in a renal transplant patient

Abstract

Background. The incidence of acute pancreatitis after renal transplantation ranges around 1%, and the mortality rate is nearly 65%. Dynamic computed tomography (CT) scan and amylase levels are valuable in the diagnosis of this rare complication. Case outline. A 29-year-old man was hospitalised with cytomegalovirus (CMV) pancreatitis after renal transplantation. An initial CT scan showed an enlarged pancreas with hypodense, heterogeneous consistency and with peripancreatic, perihepatic, mesenteric and pelvic fluid collections. After initial conservative management, follow-up CT revealed pancreatic necrosis and abscess formation. The patient underwent necrosectomy and repeated drainage of abscess facilitated by a Bogota bag, but he died 60 days after admission and five surgical procedures. Discussion. CMV pancreatitis after renal transplantation is rare and frequently fatal. In the presence of an acute abdomen after renal transplantation, the diagnosis of pancreatitis should be considered. Dynamic CT scan and measurement of amylase levels are recommended. © 2004 Taylor & Francis.