INTRODUCTION 

Presence of appendicitis and pancreatitis in a patient is very 

rare and whether it is  complication of pancreatitis resulting in 

appendicitis or two separate pathologies, is not known. There 

exists a possibility of spread of pancreatic inammatory 

exudates via the small bowel mesentery resulting in peri-

appendicitis (1). We present a case of acute abdomen which 

was diagnosed to have both appendicitis and pancreatitis.

CASE REPORT 

35 year old male with no known co morbidities presented with 

history of severe abdominal pain, loss of appetite, nausea and 

non bilious vomiting of one day duration. Pain was sudden in 

onset, severe in nature localised in epigastric and right 

lumbar region. No history of fever or bowel and bladder 

complaints. The patient denied any history of alcohol 

consumption. On examination, vitals were within normal 

limits. Abdomen was distended and had tenderness in 

epigastric and right lumbar region and bowel sounds were 

present. Per rectal examination was unremarkable. Patient 

had leucocytosis on haematological examination with raised 

serum amylase and lipase levels. Ultrasound of the abdomen 

revealed fat stranding around body of pancreas and features 

of acute appendicitis (Figure 1&2). Abdominal computed 

tomography (CT) also revealed the evidence of complicated 

pancreatitis along with uid accumulation around the 

inamed appendix (Figure 3&4). Patient was managed 

conservatively to which he responded well and was 

discharged after 10 days of admission and is under regular 

follow up.

Figure 1 : USG showing fat stranding around Pancreas

Figure 2:  USG showing blind ending tubular non 

compressible structure

Figure 3 : CECT abdomen showing Pancreatitis

Figure 4: CECT showing Appendicitis & thickened Gerota's 

fascia on Right side

DISCUSSION
Colonic complications of severe acute pancreatitis are quite 
uncommon and always occur in transverse colon and splenic 
exure (1). The incidence of such  complications is approx 7% 
including infarction, infection and transverse colon and 

DUAL PATHOLOGY OF ACUTE PANCREATITIS AND ACUTE 
APPENDICITIS IN A PATIENT PRESENTING WITH ACUTE ABDOMEN

Original Research Paper

Maj (dr) Yogesh 
Kukreja*

Graded Specialist (general Surgery), 153 General Hospital * 
Corresponding Author

General Surgery

Presence of appendicitis and pancreatitis in a patient is very rare and whether it is  complication of 
pancreatitis resulting in appendicitis or two separate pathologies, is not known. There is a requirement to 

study the association between the two. Even the management of the same is not clear. We present a case of acute abdomen which 
was diagnosed to have both appendicitis and pancreatitis.

ABSTRACT

KEYWORDS : 

VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Maj (dr) Ss 
Choudhary

Graded Specialist (radiodiagnosis), 153 General Hospital 

Maj (dr) Rajat 
Chawla

Graded Specialist (internal Medicine), 153 General Hospital 

Capt (dr) Shreya 
Srivastava

Medical Ofcer, 153 General Hospital

34 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS



splenic exure stula, however not much has been reported 
about isolated involvement of the appendix as a complication 
of pancreatitis (2). According to the reports of rare cases, there 
is a possibility that appendicitis be a rare complication of 
pancreatitis (1,3,4).
 
CONCLUSION
Not much is known about the relationship between 
pancreatitis and appendicitis. The possibility is either of dual 
pathology or that the infection is spread from the pancreas to 
the colon or vice versa. Further whether the patient should be 
managed conservatively or  by surgical intervention should 
be further studied (1).
 
REFERENCES
1. Hsia HC, Shoung LK, Wong DW. Acute pancreatitis complicated with 

periappendicitis. Zhonghua Yi Xue Za Zhi (Taipei)  2002; 65:619-
21.[Abstract]

2. Alaqqad M, Ram L, Kannan P, Abou Al Neaj M. Pancreatitis complicated by 
acute appendicitis. Hamdan Med J 2015;8:161-4. 

3. Wasnik N, Agrawal VP, Khatri KR, Khatri V. Acute pancreatitis 
masquerading as acute appendicitis – a diagnostic dilemma. IJBAR 2013

4. Wasnik N, Agrawal VP, Khatri KR, Khatri V. Acute pancreatitis 
masquerading as acute appendicitis – a diagnostic dilemma. IJBAR 2013; 
4. 

VOLUME-8, ISSUE-10, OCTOBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

  X 35GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS