Acute pancreatitis with peritoneal fat necrosis with atypical clinical symptoms

Introduction: Acute pancreatitis (AP) is characterized by severe and persistent abdominal pain due to pancreas inflammation. This study aims to describe the diagnostic and therapeutic steps chosen to treat patients with acute pancreatitis due to cholelithiasis who have experienced necrosis of the peritoneal fat tissue with atypical symptoms using a simple examination.Case Presentation: The patient complained of abdominal pain in the left hypochondrium. The pain was described as intermittent and sharp, without spreading, and is accompanied by nausea and vomiting, persisting for the past two weeks. The following day, the abdominal pain became more severe and persistent, especially with changes in position. Abdominal examination shows distended, defensive muscles and decreased bowel sounds. The ultrasound examination results showed that there were gallstones in the neck bladder measuring 5 mm and minimal fluid between the intestines and McBurney. Abdominal plain radiograph (BOF-LLD) results provide a ground glass appearance in the abdominal cavity. The patient underwent exploratory laparotomy, antibiotics and supportive therapy. The patient was discharged on day 9.Discussion: Computer tomography can be used in uncertain diagnosis, and ultrasonography (USG) cannot visualize AP. However, in cases of signs of peritonitis, surgery can be used for therapy and to confirm the diagnosis. Conclusion: Signs of peritonitis increase the urgency in this patient; prompt exploratory surgery is performed to remove the focus of infection and help confirm the diagnosis. In addition to administering antibiotics and supportive therapy, surgery can provide satisfactory results