Fig. 16

In an 84-year-old male with malaise, appetite loss, epigastric tenderness and protracted low-grade fever, contrast-enhanced CT detected a vast retroperitoneal abscess (+) with some internal gas and residual enhancing pancreatic parenchyma at body and tail, which was indissociable from the distal gastric antrum and pylorus: the latter showed circumferential mural thickening with oedematous submucosa (*) and hyperenhancing mucosa (thin arrows). Additionally, focal communication (arrowheads in c, d) was identified between pancreatic abscess and inflamed digestive tract. The fistulisation site corresponded to endoscopic finding (image in inset d) of large posterior bulbar ulcer. Laparotomic surgery required extensive dissection, confirmed a vast, stinky purulent and necrotic collection, fixed to the stomach and deformed pylorus, and was completed with gastric resection and Billroth-II gastrojejunostomy. Pathology confirmed severe transmural ulcerated peptic gastro-duodenitis, without malignant changes [Adapted from Open Access ref. no [21]]