A Rare Presentation of Purplish-Brown Peripancreatic Fluid in Acute Pancreatitis: A Case Study

Abstract

Introduction: Acute pancreatitis is an inflammatory condition resulting from premature activation of pancreatic enzymes, leading to autodigestion, necrosis, and potential systemic complications. Pancreatic pseudocysts commonly arise as sequelae of acute pancreatitis, typically containing clear or straw-colored fluid. We have reported a rare case of acute pancreatitis with a large pancreatic pseudocyst containing purplish-brown fluid, uncommon finding, not commonly described in literature.
Case Presentation: We report the case of a 28-year-old male presenting with severe abdominal pain, nausea, and vomiting, worsened by oral intake. Contrast-enhanced CT revealed a large peripancreatic loculated collection (14.0 × 9.5 cm) consistent with a pseudocyst, along with a small intrapancreatic pseudocyst, splenomegaly, and moderate hyperdense peritoneal fluid. Image-guided drainage yielded purplish brown, slightly hazy fluid.
Discussion: The unusual fluid discoloration likely reflects haemoglobin degradation pigments from prior intracystic hemorrhage, despite the absence of active bleeding on imaging. Recognition of such not-so-typical features is essential to avoid missed vascular complications and to guide timely interventions for better outcomes in patient.
Conclusion: This rare presentation focuses on diagnostic significance, early recognition of such atypical features, along with detailed radiological evaluation and biochemical analysis of drained fluid, is essential to guide appropriate management and prevent serious complications.