Cuando una peritonitis no parece una peritonitis / When a peritonitis does not seems like a peritonitis

La pancreatitis aguda es una entidad que forma parte del diagnóstico diferencial del abdomen agudo de origen apendicular. Aunque su incidencia es baja, se encuentra en aumento y su correcto diagnóstico evita cirugías innecesarias. El objetivo del trabajo es describir la pancreatitis aguda como diagnóstico diferencial de abdomen agudo de origen apendicular. Se realiza un estudio retrospectivo de los pacientes remitidos para valoración de cirugía pediátrica en la urgencia con sospecha de patología apendicular, que fueron diagnosticados finalmente de pancreatitis aguda desde el año 2010. Se incluyen 5 pacientes. Un paciente fue intervenido y su diagnóstico se realizó en el 5º día postoperatorio. La edad mediana al diagnóstico fue de 5 años (rango de 8 meses a 6 años). La mediana de leucocitos en sangre fue de 16.600 /μL (13.400-31.900 /μL), mediana de neutrofilos 14.432 /μL (11.400-29.348 /μL), mediana PCR 11 mg/L (155-4,6 mg/L), mediana amilasa sérica al diagnóstico 651 U/L (10-1.443 U/L). Todos los casos fueron estudiados con ecografía abdominal y tomografía computarizada o resonancia magnética nuclear. Un caso presentó episodios recurrentes de pancreatitis y como complicación un pseudoquiste y una fístula pancreática, precisando a los 9 meses del inicio del cuadro clínico una derivación cistoentérica en Y de Roux. La mediana global de seguimiento de la serie es de 10 meses, con un rango entre 1 y 22 meses, encontrándose todos los pacientes asintomáticos (AU)

Acute pancreatitis should be considered in the differential diagnosis of acute abdominal pain. Although its incidence is low, it has increased in the last years; therefore, an accurate diagnosis is necessary to avoid inappropriate surgeries. The aim of this study is to describe acute pancreatitis in the context of acute abdominal pain, which suggests appendicitis. We performed a retrospective study of all the patients who were admitted in the emergency department due to suspected appendicitis but were finally diagnosed of acute pancreatitis since 2010. Five patients were included in the investigation. One of them underwent surgery and the diagnosis was made on the 5th postoperative day. Median age at diagnosis was 5 years (range from 8 month to 6 years). Median white blood cell was 16,600 /μL (13,400-31,900 /μL), Median differential count of white blood cell was 14,432 /μL (11,400-29,348 /μL) and Median PCR 11 mg/L (155-4.6 mg/L). Median serum amylase at diagnosis was 651 U/L (10-1,443 U/L). All cases were studied with ultrasound and computerized tomography or nuclear magnetic resonance. One case had recurrent episodes of pancreatitis and was complicated by the development of a pseudocyst and a pancreatic fistula, requiring an Y-en-Roux cysto-enteric anastomosis . The median follow up period was 10 months (range: 1 to 22). All patients are asymptomatic at the moment (AU)

[When a peritonitis does not seems like a peritonitis]. / Cuando una peritonitis no parece una peritonitis.

Acute pancreatitis should be considered in the differential diagnosis of acute abdominal pain. Although its incidence is low, it has increased in the last years; therefore, an accurate diagnosis is necessary to avoid inappropriate surgeries. The aim of this study is to describe acute pancreatitis in the context of acute abdominal pain, which suggests appendicitis. We performed a retrospective study of all the patients who were admitted in the emergency department due to suspected appendicitis but were finally diagnosed of acute pancreatitis since 2010. Five patients were included in the investigation. One of them underwent surgery and the diagnosis was made on the 5th postoperative day. Median age at diagnosis was 5 years (range from 8 month to 6 years). Median white blood cell was 16,600/microL (13,400-31,900/microL), Median differential count of white blood cell was 14,432/microL (11,400-29,348/microL) and Median PCR 11 mg/L (155-4.6 mg/L). Median serum amylase at diagnosis was 651 U/L (10-1,443 U/L). All cases were studied with ultrasound and computerized tomography or nuclear magnetic resonance. One case had recurrent episodes of pancreatitis and was complicated by the development of a pseudocyst and a pancreatic fistula, requiring an Y-en-Roux cysto-enteric anastomosis. The median follow up period was 10 months (range: 1 to 22). All patients are asymptomatic at the moment.