PMC7708617_01
CT scan with IV contrast demonstrating pancreatic necrosis with surrounding inflammation.
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Computed tomography (CT) of the abdomen at the time of admission showed a small gallstone in gallbladder without any signs of cholecystitis, or intra or extrahepatic biliary ductal dilatation, as well as greater than 75 % necrosis of pancreas with surrounding inflammatory changes as well as non-occlusive splenic vein thrombosis (Fig. 1).
A: Initial CT scan demonstrating gastric perforation in the lesser sac. B: CT scan demonstrating second perforation in greater curvature of stomach.
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On post-operative day (POD) 10, a repeat CT scan of abdomen/pelvis was performed due to persistent leukocytosis despite patient being on antimicrobial and anti-fungal therapy and it showed a posterior wall gastric perforation (Fig. 2A). One week after gastric perforation repair, patient had another febrile episode with elevated WBC count, and another posterior wall gastric perforation was discovered on CT imaging (Fig. 2B).
Histology slides demonstrating A: necrotic pancreas (black arrow) and cluster of CMV cells (yellow arrow) slides and B: positive immune stain for CMV (black arrow).
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Her pancreatic histopathology report from last operation showed pancreatic necrosis with clusters of cells with CMV inclusion bodies on Hematoxylin and Eosin (H&E) and CMV antibody stains (Fig. 3).