A huge preperitoneal collection following acute necrotizing pancreatitis: A case report and the management approach

Introduction and importance: Fluid collection is a critical complication of acute necrotizing pancreatitis. It is usually formed near the pancreas, but unusual collection sites have also been reported. Anterior extraperitoneal or preperitoneal collections following acute pancreatitis are rare and must be differentiated from pancreatic ascites, which is a collection of fluid in peritoneal cavity. Case presentation: A 68-year-old man with a suspected pancreatic mass presented to the emergency department, complaining of abdominal pain and gradual abdominal distention. He had experienced epigastric pain, nausea, vomiting, progressive abdominal distention, and icterus for two weeks prior to admission. An abdominopelvic CT scan revealed extensive necrotizing pancreatitis with a prominent extraperitoneal collection. The collection had extended from the retroperitoneal space to the anterior extraperitoneal or preperitoneal space and had pushed the abdominal viscera backward. We managed the patient with the "Step-up" approach, and the patient was discharged after four weeks.Clinical discussion & conclusion: Preperitoneal fluid collection can rarely occur following acute necrotizing pancreatitis. Here, we suggested two possible routes for fluid migration from the retroperitoneum to the preperitoneal space. Using minimally invasive techniques such as percutaneous drainage of peripancreatic collections could reduce morbidity and mortality in critically ill patients diagnosed with necrotizing pancreatitis.