Fatal cerebral hemorrhage associated with acute pancreatitis: A case report

RATIONALE: Pancreatic encephalopathy (PE) refers to the abnormalities in mental status that complicate acute pancreatitis (AP). We report the case of a patient who developed AP that was complicated by PE and followed by fatal cerebral hemorrhage. PATIENT CONCERNS: A 41-year-old male patient with AP that initially manifested with PE and was subsequently complicated by fatal cerebral hemorrhage. DIAGNOSES: A head computed tomography (CT) scan showed a fatal intracerebral hemorrhage located in the occipital lobe, and an abdominal CT scan presented a large amount of peripancreatic fluid collections. INTERVENTIONS: The patient received a hematoma evacuation. The volume of the hematoma was approximately 15 mL. A consequent open pancreatic necrosectomy was performed to remove all necrotic tissues and to drain the peripancreatic fluid collections. OUTCOMES: The patient could perform his normal daily activities efficiently, and no abnormality was observed in the physical examination 3 months after his discharge. LESSONS: Although uncommon, PE should be properly monitored. Once the neurological symptoms of a patient dramatically worsen within a short time, the possibility of fatal cerebral hemorrhage should be considered.