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Systemic Inflammatory Response and Fat Necrosis of Perineal Soft Tissues: A Rare Complication of Bladder-Drained Transplanted Pancreas Leak

Sara A. Mansfield, William J. Melvin, Brent Carlyle, Steven Sun, Justin T. Huntington, David C. Evans and Amy Rushing

Pancreatic transplant is increasingly being performed for management of diabetes. There are known complications, specifically related to exocrine drainage of the pancreas, with enteric versus bladder drainage being options. Here we present a unique complication of leakage of the pancreaticocystostomy, likely secondary to severe urethritis and obliteration of the urethra. Accumulation of pancreatic enzymes in the subcutaneous tissues led to fat necrosis of the scrotum and groin with severe systemic inflammatory response syndrome. Presentation mimicked an infectious soft tissue infection that failed antibiotic management. This highlights a unique clinical entity mimicking infection. This patient required debridement, urinary diversion, and a multidisciplinary approach to treatment.