Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy

Copyright © 2021 W. G. P. Kanchana et al..

INTRODUCTION: Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day.

CONCLUSION: The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:2021

Enthalten in:

Case reports in surgery - 2021(2021) vom: 04., Seite 5532096

Sprache:

Englisch

Beteiligte Personen:

Kanchana, W G P [VerfasserIn]
Dharmapala, A D [VerfasserIn]
Dassanayake, B K [VerfasserIn]
Wasala, W M A S B [VerfasserIn]
Galketiya, K B [VerfasserIn]

Links:

Volltext

Themen:

Case Reports

Anmerkungen:

Date Revised 21.04.2022

published: Electronic-eCollection

Citation Status PubMed-not-MEDLINE

doi:

10.1155/2021/5532096

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM323712711