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.

Dengue fever is a mosquito-borne viral infection common in tropical countries with increasing incidence. The clinical manifestations can range from asymptomatic or mild infection to multiorgan failure. The latter is also called “Expanded dengue syndrome,” and it carries a high rate of mortality and morbidity. Intensive care management of such complicated cases is a challenging task for the treating physician, which requires intense monitoring and a multidisciplinary approach for decision making. We report an atypical case of an expanded dengue syndrome presented with subarachnoid haemorrhage associated with moderate thrombocytopenia, cranial diabetes insipidus, and haemophagocytic lymphohistiosis in a young healthy female patient.

The anesthetic management of a patient with myotonia dystrophica and placenta previa with accreta, presenting for elective cesarean section at 35 weeks of gestation is presented. The onset of muscle weakness had been delayed and presented during the second trimester of pregnancy. The pregnancy was further complicated by findings of restrictive lung disease and anemia. After delivery of the baby, the patient required a sub total hysterectomy due to failure of the placenta to separate. This case highlights the successful application of regional anesthesia in a complicated myotonia dyotrophica parturient with relative contraindication for GA.

A pancreatoduodenectomy involves the removal of a tumour of the peri ampullary region and head of the pancreas. It is a technically difficult procedure requiring experienced anaesthesia and surgical teams. We report the peri-operative management of a patient undergoing laparoscopic pancreaticoduodenectomy.