Combined minimally invasive management of infected peripancreatic necrosis: two cases report

Abstract

Infected peripancreatic necrosis (IPN) is the most threatening complication of severe acute pancreatitis. Surgical necrosectomy is still the procedure of choice in the treatment of IPN and debridement is usually performed through laparotomy. Case 1: A 40-year-old man was referred for the complication of the acute pancreatitis after endoscopic ampullectomy due to tubular adenoma with severe dysplasia. CT scans revealed a diffuse acute necrotic collection (ANC) involving the body and tail of the pancreas which extended anterior and inferior to the pelvic cavity. The patient received maximal conservative treatment including intensive fluid replacement, enteral and parenteral nutrition after endoscopic pancreatic duct insertion. The patient's clinical condition deteriorated during the 4 week of the disease with fever and increased serum C-reactive protein of 28.mg/dL despite of antibiotics, endoscopic pancreatic drainage and two times of ultrasono-guided PCD. He underwent laparoscopic pancreatic necrosectomy through mesocolic window. The postnecrosectomy cavity was thoroughly irrigated and closed suction drains were left for negative pressue drainage. Patient was discharged on the 35th days after laparoscopic surgery and patient remains asymptomatic for 4 years. Case 2: Fifty six year-old man was admitted for abdominal pain after heavily alcoholic drinking. An abdominal CT showed diffuse infiltrating inflammation around the pancreas suggesting acute pancreatitis. Despite of conservative treatment, follow up CT showed huge infected peripancrtic necrotic abscess. H received multiple procedures for percutaneous cavity drainage(PCD) but failed in persistent fever. So he underwent laparoscopic peripancreatic necrosectomy and multiple drainages. He was improved with almost complete resolution during 3 month period.