Acute Complicated Necrotising Pancreatitis Treated with Video-Assisted Retroperitoneal Debridement

Abstract

Acute necrotising pancreatitis is a complex disease with high morbidity and mortality rates. In cases of infected necrosis, treatment consists of a step-up approach involving endoscopic or mini-invasive surgical methods. In some cases, there are extremely rare complications. In addition, the underlying comorbidities worsen the course of the disease. We report a case of a 32-year-old male with acute necrotising pancreatitis complicated with recurrent retroperitoneal abscesses, sepsis, iatrogenic pylephlebitis, exacerbation of underlying Crohn’s disease, and the outcome of the treatment was successful. During the period of hospitalisation, one ultrasound-guided percutaneous drainage, two computed tomography-guided punctures of the retroperito-neal space (percutaneous and transhepatic) and five video-assisted retroperitoneal debridement procedures were carried out. The patient was discharged after 185 days of hospitalisation.

Fatal peritonitis — causes, contributing factors and diagnostic challenges: an autopsy cases study

“…The key to treating mesenteric ischaemia properly is early diagnosis or it is rapidly fatal, but as the authors highlight, it has various and nonspecific presentation. If diagnosis occurs within 24 hours after onset of symptoms, the survival rate is 50 percent, but if later then the odds of survival are only 20 to 30% (Oldenburg et al, 2004;Adaba et al, 2015;Ðapovalovs et al, 2021).…”

“…It is a condition that may prove rapidly fatal in both old and young, which worldwide studies have proven (Malangoni and Inui, 2006;Tochie et al, 2020). In the western part of the world, elderly have a higher risk in developing severe sepsis in intraabdominal infections, which may become fatal since they have less physiological reserve and multiple comorbidities; common causes are surgical disorders like diverticulitis, cholecystitis, pancreatitis, malignancies as colon cancer and mesenteric ischaemia (Riche et al, 2009;Khan et al, 2013;Dimopoulos et al, 2017;Ðapovalovs et al, 2021). However, elsewhere the age at which the patients are admitted to clinics due to peritonitis tend to be younger.…”