Another case has been followed by us. 53 yo male, diabetes non
insulinodependent. Had Glybenclamide 5 mgrs. twice a day. Not well
compensated, glycemia over 200,presents with a severe pain in his upper
abdomen, fever, jaundice,high levels of amylase and lypase. .WBCC over
46 K.,USN reveals a gallbladder full of stones,CBD dilated to 8 mms.ERCP
+ ES performed,permits drainage of purulent content and extraction of
stones (2). AB coverage with cephoperazone + Flagyl. Diabetes needs
control with Cristaline Insulin administered by infussion pump (90 units
per day). TPN at the beginning,then intestinal feeding through a
The patient hasn't improved much.Very difficult management of his
diabetes. A CT scan showed an acute pancreatitis type D Ranson
Balthazar. Huge enlargement of the gland with a collection near the
tail of about 8 x 6 x 4 cms. Inhomogenous contents. The patient
continued to look septic and a percutaneous drainage under CT scan
control was performed last Wednesday. 30 cc of pus was collected and a
tube left in place. Interventional radiologists continue daily control
of the collection, washing the cavity with saline. I'll see him again
1.- Do you think percutaneous drainage will be enough?
2.- Do you believe that surgery should be kept in mind to be done soon?
3.- All other routine measures are being done in the management of his
pancreatitis.Do you suggest something special?
4.- I want to remind you that 5 similar cases we've had in the last
months have been treated with percutaneous drainage,up to 3 catheters
left in place, and results have been excellent with total recovery of