Massive Fluid Collection Research Articles

A rare case of hepatic subcapsular hematoma presenting with severe anemia in a 20-hour old term newborn: case report

Hepatic subcapsular hematoma is an extremely rare clinical condition in the neonatal period. Being a life-threatening emergency, it requires prompt diagnosis and management. In a newborn presented with severe anemia, hypovolemic shock, and abdominal distention with hemoperitoneum without any identifiable risk factors hepatic subcapsular hematoma should be considered. Newborns may develop catastrophic acute and long-term complications if the diagnosis is not made timely. Obstetricians, pediatricians, neonatologists and pediatric surgeons should have a high of the index of suspicion of hepatic subcapsular hematoma in newborns to avoid delay in the diagnosis and to reduce neonatal morbidity and mortality. 
 Here, we report a 20 hour’s old male term newborn diagnosed with Hepatic Subcapsular Hematoma after he presented with progressive abdominal distension and severe anemia. Abdominal ultra-sound showed a well-defined round heterogenic echogenic liver mass and massive intra-peritoneal fluid collection. The newborn was managed in the Neonatal Intensive Care Unit with Fresh Frozen Plasma transfusion, Whole blood transfusion and vitamin K administration, and discharged im-proved after a week. A high index of clinical suspicion is necessary to avoid delayed diagnosis and life-threatening complications among health professionals in the neonatal intensive care unit.

A case of massive pancreatic fluid collection managed with percutaneous pigtail drainage as step-up approach

A 19-year-old male presented to us with complain of acute epigastric pain for 2 weeks duration. The pain was dull aching in nature, radiating to back. On examination he was of average built and nutrition, dysnoic and tachypnoic with pulse rate of 140 /min, respiratory rate 26 /min, blood pressure 140/80 mmHg, saturation on room air 90%, bilateral (b/l) pedal edema present. On per abdomen examination abdomen was distended, fullness was present in bilateral upper abdomen. So, after thorough investigation, diagnosis of acute necrotizing pancreatitis was made and subsequently planned for ultrasonography (USG) guided percutaneous pigtail drainage as step-up approach in view of multiple loculated collections. Nasojejunal tube was inserted for entral nutrition. First perihepatic collection was drained on day 1, then lesser sac and pelvis drainage was done on day 2. At times, the collections may extend into the subhepatic space from the lesser sac through foramen of Winslow. Such subhepatic collections are intraperitoneal rather than retroperitoneal and there is a significant risk of peritoneal leak during endoscopic transmural drainage that may cause peritonitis. The collections may extend to either or both paracolic gutters retroperitoneally and at times to pelvis. In these retroperitoneal collections where endoscopic transmural drainage that may cause peritonitis, percutaneous pigtail drainage as a step-up approach is a feasible option.

Empyema Thoracis Caused by Klebsiella Spp and Escherichia coli Co-Infection - An Uncommon Isolation with Atypical Presentation

Empyema thoracis is the collection of pus in the pleural space. A 9-year-old boy presented with a 3-day history of high grade continuous fever, a day history of abdominal pain, distension and fast breathing. Examination findings: acutely ill child, febrile, in respiratory distress. Chest findings: tachypnea, dull percussion note and decreased air entry on the right hemithorax. Chest radiograph: massive fluid collection in the right hemithorax. A pleural tap yielded frank pus that was sent for microscopy, culture and sensitivity (MCS). Escherichia coli was cultured which was sensitive to fluoroquinolones. Klebsiella spp was also cultured from the blood sample taken for MCS and yielded the same sensitivity. Patient responded well to tube thoracostomy drainage and administration of antibiotics. Empyema thoracis with the isolation of two-gram negative organisms in a previously healthy child is rare.

Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

Pseudothrombophlebitis syndrome in a rheumatoid arthritis patient with swollen calf and persistent itching: a case report

BackgroundBaker’s cyst is a benign lesion that results from degenerative or inflammatory diseases of the knee joint. When Baker’s cyst ruptures, it may simulate deep vein thrombosis known as Pseudothrombophlebitis syndrome with calf pain, swelling and redness. Pseudothrombophlebitis syndrome without thrombus in popliteal veins has distinct treatment choice than deep vein thrombus.Case presentationIn this report, we presented a 47 year-old male rheumatoid arthritis patient with complaints of redness, pain and swelling on his right calf. Pseudothrombophlebitis syndrome was diagnosed due to ruptured Baker’s cyst.ConclusionsWe used musculoskeletal ultrasound for both differential diagnosis and treatment of pseudothrombophlebitis syndrome. Ultrasonography revealed massive fluid collection within muscle layers. 280 cc inflammatory fluid was aspirated simultaneously. We also emphasized the importance of ultrasonography in diagnosis and treatment of Pseudothrombophlebitis syndrome with this report.

A rare postoperative complication of anterior lower thoracic instrumentation: diaphragmatic laceration with hemothorax

To highlight the importance of preventing visceral injury due to prominent anterior implants at the spinal column. A 52-year-old man with cord compression was treated with a T9/10 discectomy and instrumented fusion via a right thoracotomy and trans-pleural approach. Postoperatively, he had improved lower limb numbness. However, after a bout of coughing, there was sudden increase in chest drain output, hemodynamic instability and massive fluid collection in the right chest cavity. Emergency re-exploration of the thoracotomy was performed and a 6cm laceration of the right postero-medial diaphragm was identified as the bleeding source and was found to be in close proximity with the locking nut of the anterior implants. The laceration was repaired and a soft synthetic patch was used to cover the implants. Postoperatively, the hemothorax resolved and the patient recovered from the neurological deficit. Prevention of diaphragmatic injury can be performed using lower profile and less sharp-edged implants. Implant coverage with a soft synthetic material is necessary if unable to perform direct repair of the parietal pleura over the implants.

Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report.

Laser enucleation and morcellation of the prostate is an increasingly used surgical management of benign prostatic hyperplasia. However, it can cause several complications including capsular perforation, ureteral orifice injury, and bladder mucosal morcellation injury. Herein, we report a case of severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser surgery of the prostate. The patient experienced massive abdominal distension and severe respiratory difficulty after the procedure. Although immediate postoperative cystogram showed no leakage of contrast dye, the computed tomography scan of the abdomen and pelvis showed massive fluid collection in the abdominal pelvic cavity suggesting bladder wall injury. After percutaneous drainage of intraperitoneal fluid, abdominal distention and dyspnea were relieved.

Massive Pleural Fluid Collection in Adult Nigerians.

Background. There are no available literatures on massive pleural effusions (MPE) in our country. Aim. To determine the aetiology of MPE and compare the mortality rate between malignant and nonmalignant MPE in adult Nigerians. Methods. A prospective study of all the patients diagnosed with nontraumatic pleural fluid collections for one year in two tertiary federal hospitals in Southern Nigeria. A total of 101 consecutive patients with pleural fluid collections were studied. Diagnoses were made by clinical features and laboratory and radiological investigations. Results. Forty-eight patients (47.5%) had MPE with a mean age of 43 years ± 14.04 and 35 were females. Thirty patients (62.5%) were diagnosed with nonmalignant conditions (21 from pulmonary tuberculosis (PTB) and 9 from other causes). Haemorrhagic pleural collections were from malignancy in 12 (30.8%) and from PTB in 6 (15.4%). Straw-coloured collections were from malignancy in 9 (23.1%), from PTB in 8 (20.1%), and from posttraumatic exudative effusion in 3 (7.7%). Compared with nonmalignant MPE, patients with malignant collections had higher mortality within 6 months (8/18 versus 0/30 with a P value of 0.000). Conclusion. The presentation of patients with nontraumatic haemorrhagic or straw-coloured MPE narrows the diagnosis to PTB and malignancy with MPE cases being a marker for short survival rate.

O3-13-3 - Efficacy and Safety of Gemcitabine as First-Line Therapy in Patients Aged 65 and Older with Advanced Pancreatic Cancer

Background: We have previously reported the efficacy and safety of gemcitabine (GEM) therapy in patients aged 75 years and older with advanced pancreatic cancer (APC): (1) 98% of the patients had good PS, and initial dose reductions were performed in 40%; (2) the efficacy was inferior to that of previous reports, which was assumed to result from low relative dose intensity (RDI) and proportion of patients who received second-line therapy. We assessed the efficacy and safety in patients aged 65-74 years.Methods: We retrospectively reviewed 187 consecutive patients aged 65-74 years with APC who received GEM as first-line therapy at our institution between September 2002 and March 2013. Inclusion criteria were as follows: PS0-2, adequate organ function, no massive fluid collection, no critical complication, adequate oral intake, and no active concomitant malignancy.Results: This analysis identified 137 patients. Patients characteristics were as follows: median age 70 years (range, 65-74), male/female 75/62, PS0/1/2 59/62/16, unresectable/recurrence 124/13, and metastasis +/- 116/21. Median number of administration was 10 times (1-110). Initial dose reductions were required in 5 (3.6%) patients. The median RDI was 79.8% (31.5-99.9). Out of the 135 patients with measurable lesion, the response rate was 7.4%, and disease control rate was 64.4%. The median progression free survival and median overall survival were 3.7 months and 9.4 months, respectively. Grade 3/4 adverse events were neutropenia (46.0%), anemia (12.4%), thrombocytopenia (12.4%), blood bilirubin increased (10.4%), and biliary tract infection (13.1%). Second-line therapy was administered in 91 (67.9%) patients.Conclusions: 11.7% of the patients aged 65-74 years had PS2, but the efficacy and treatment exposure of GEM therapy were comparable to those of previous reports, and toxicity was tolerable.

A patient with a floating kidney and nephrotic syndrome

Asymptomatic retroperitoneal fluid is rarely detected. We encountered a young man with known nephrotic syndrome who presented with left-sided abdominal pain. He had very little peripheral edema, but a massive fluid collection around a "floating" left kidney, as determined by three different imaging studies. Large amounts of fluid and a cyst surrounding the kidney were removed laparascopically and malignancy was excluded. The patient had a rare benign cystic mesothelioma together with focal-segmental glomerulosclerosis. Both diseases do not seem to be causally related. Complete surgical resection of the mesothelioma is the definitive treatment. If resection is incomplete, recurrence is frequent. Indeed, when our patient returned some years later for an elective hernia repair, the fluid collection had recurred.

Massive liver mass and parenteral nutrition extravasation secondary to umbilical venous catheter complications

Umbilical vein catheters (UVC) are widely used in neonatal medicine. Serious complications from UVC placement are uncommon but do exist, including infection, thrombosis, arrhythmias, and hemorrhage. Although rare, hepatic complications, in particular, have been associated with significant morbidity and mortality. Correct positioning of the catheter prior to starting infusion of hyperosmolar solutions and early recognition of UVC-related complications are crucial in minimizing iatrogenic injury. We report the case of a neonate who was found at 10 days of age to have large pleural and peritoneal effusions and a massive fluid collection in the liver due to malposition of a UVC.

A case of emphysematous cystitis diagnosed by exploratory laparotomy

Emphysematous cystitis is a rare form of infection. Well known symptoms are: dysuria, urinary frequency and lower abdominal pain. We experienced a case of emphysematous cystitis presented with atypical peritoneal sign and computed tomography findings of massive intra-peritoneal fluid collection and abnormal gas appearance in pelvic space. Due to its presentation as acute abdomen, patient underwent exploratory laparotomy and the diagnosis of emphysematous cystitis was established. As far as we know, our case is the first report of emphysematous cystitis with intra-peritoneal fluid collection.

Massive hemothorax due to diaphragmatic endometriosis after a laparoscopic cystectomy of an ovarian endometrioma in a patient without a history of thoracic endometriosis

Severe hemothorax is a rare complication after laparoscopic surgery for endometriosis, and the causes and proper management are not well understood. We report here the extremely rare case with massive hemothorax after laparoscopic surgery for ovarian endometrioma. A 40-year-old woman, gravida 1, para 1, underwent laparoscopic cystectomy of ovarian endometrioma. On postoperative day 2, she had progressive anemia (Hb 5.3) as well as dyspnea. A chest X-ray and computed tomography showed massive fluid collection in the right thoracic cavity, suggestive of intrapleural bleeding. Thoracoscopic operation was performed and a total of 930 ml of blood retention in the right thoracic cavity was found. Scattered small endometriotic lesions were present on the pleural surface of the right diaphragm; pulsatile active bleeding was confirmed from one of these. Furthermore, two endometriotic lesions had perforated into the intraperitoneal cavity. The diaphragm containing bleeding spots was thoracoscopically resected and sutured. After thoracoscopic surgery, the dyspnea and anemia resolved. On postoperative day 5, the patient left the hospital. The present report reminds us of the importance of paying special attention to postoperative-thoracic complications caused by diaphragmatic endometriosis if the patient shows respiratory symptoms.

Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game

A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.

Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report

IntroductionUterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture.Case presentationA 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34th week due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed.ConclusionIntestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.

Pancreatic adenosquamous carcinoma presenting as splenic rupture: Report of a case

A 58-year-old female patient presented with the sudden onset of left upper quadrant pain. The physical examination revealed the presence of shock status. Abdominal computed tomography revealed splenomegaly with a huge mass inside the spleen, and massive fluid collection in the abdominal cavity. After splenic artery embolization, laparotomy was performed. The operative findings revealed intra-abdominal hemorrhage and rupture of the lower pole of the spleen. Furthermore, a palpable solid mass was observed at the splenic hilum, and distal pancreatectomy with splenectomy was performed. The macroscopic findings revealed a pancreatic tail tumor at the splenic hilum directly invading the splenic parenchyma. Microscopic examinations showed the tumor to consist of squamous cell carcinoma. Furthermore, old and new thrombi were observed inside small splenic arteries. These findings were considered to represent invasion of pancreatic adenosquamous carcinoma to the spleen, and rupture of the spleen was attributed to splenic ischemia resulting from cancer invasion and splenic vein obstruction.

A kidney gone astray under pressure.

A 58-year-old man underwent elective repair of a type 2 thoracoabdominal aortic aneurysm. On post-operative day 10, he developed acute onset of dyspnoea and abdominal pain. He was hypotensive and oliguric, with a rigid and distended abdomen. Laboratories showed acute renal failure (ARF) with a rise in the serum creatinine to 2.7 mg/dL from a baseline of 1.4 mg/dL. Intra-abdominal pressure (IAP) measured via intravesical cannulation was 47 mmHg, consistent with grade 4 intra-abdominal hypertension [1]. A diagnosis of abdominal compartment syndrome (ACS) was made. Computed tomography (CT) of the abdomen and pelvis revealed a massive retroperitoneal fluid collection (asterisk) displacing the left kidney (solid arrow) from its normal position into the right upper quadrant (Figure ​(Figure1).1). The spleen (arrowhead) and bowel were also shifted, while the right kidney (hollow arrow) remained in the right retroperitoneum. Emergent decompressive laparotomy was performed with evacuation of 10 L of fluid and placement of a retroperitoneal drain. IAP decreased to 8 mmHg with resolution of the ARF. During his convalescence, the patient had persistently high drain outputs of 4–5 L a day suspicious for a chyle leak. After post-pyloric administration of heavy cream, the retroperitoneal fluid triglyceride level increased from 16 mg/dL to 477 mg/dL consistent with chylous fluid. The retroperitoneum was explored and multiple chyle leaks were seen along the aortic aortomy in the aneurysm sac and were ligated. The patient made a full recovery, and a subsequent CT angiogram to evaluate the aneurysm repair demonstrated return of the left kidney (solid arrow) to its normal position (Figure ​(Figure22). Fig. 1 Contrast-enhanced computed tomography of the abdomen and pelvis. The abdominal contents, including the left kidney (solid arrow) and spleen (arrowhead), are displaced into the right upper quadrant by a large retroperitoneal fluid collection (asterisk). ... Fig. 2 Contrast-enhanced computed tomography of the abdomen and pelvis performed 2 months after abdominal decompression. The retroperitoneal fluid collection is no longer present and the left (solid arrow) and right (hollow arrow) kidneys are back to their normal ... ACS is common in critically ill patients after abdominal trauma or surgery or aggressive volume resuscitation with the development of ascites. Renal injury is thought to be due to decreased renal perfusion from extrinsic compression of the kidneys and low cardiac output from impaired venous return [2]. Abdominal decompression is the hallmark of treatment in severe cases. Although ACS is an infrequent complication of aortic surgery, vigilance should be maintained as this case illustrates. Conflict of interest statement. None declared.

Ultrasound ileus diagnosis

Bowel obstruction is an acute alarming situation with limited diagnostic conditions. Therapeutic decisions must be taken in time. Diagnostic differentiation between incomplete or complete bowel obstruction, intestinal obstruction and paralytic ileus is often uncertain and the underlying cause difficult to detect. Besides plain films in acute abdomen the ultrasound examination presents important additional informations: 1st Dilated intestinal loops and gas caps correlate with the characteristic x-ray finding, i.e. erected dilated intestinal loops with fluid levels. The location of the obstruction is defined in small bowel obstruction by differentiation between jejunum (with Kerckring folds) and ileum (without Kerckring folds). In large bowel obstruction the caecum is dilated and a collapse of the distal colon is detectable. 2nd Additional sonographical findings are: oedema of the intestinal walls, hyperpendulum peristalsis or absence of peristalsis, sedimentation of intestinal contents, pearlstring-like lined up gas bubbles under the ventral intestinal walls, and concomitant ascites. Duplex sonographical studies of the intestinal peristalsis may help to differentiate between mechanical obstruction and paralytic ileus. 3rd In bowel obstruction stenoses can be detected as a result of tumour, Crohn's disease diverticulitis, invagination, strangulated hernias or gall stone ileus. Intestinal adhesions cannot be found by ultrasound. Small and large bowel is dilated in paralytic ileus. Numerous causes like acute pancreatitis, ureteral colic, free gastrointestnal perforation and so on can be diagnosed. 4th In ileus of vascular disorder early diagnosis is high important, but inspite of colour flow imaging diagnostic possibilities are limited. 5th Sonographical diagnosis is of special interest when the x-ray plain films is "empty". The lack of massive fluid collection and meteorism allows an optimal ultrasound examination. In this early phase disorders of peristalsis and intestinal walls are reliably found, and it is easier to find the cause of bowel obstruction. In this way the definitive diagnosis can be arrived at earlier, because it still takes up to 6 hours to obtain the classical x-ray finding. There is a rule that the earlier ultrasound is done, the more findings one will get.

Complications and Benefits from Drainage of Massive Pleural Effusions

In their contribution to Images in Emergency Medicine in the October 2006 issue of Annals of Emergency Medicine, Platts-Mills and Burg nicely illustrate reexpansion pulmonary edema as one of the possible complications of rapid drainage of a large pleural effusion.1Platts-Mills T.F. Burg M.D. Reexpansion pulmonary edema.Ann Emerg Med. 2006; 48: 475Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar A second lesser known but actually more severe complication of tube thoracostomy can occur if severe hypoalbuminemia exists; a rapid fluid shift depletes intravascular volume leading to cardiovascular collapse.2Kinaswetz G.T. Keddiss J.I. Hepatic hydrothorax.Curr Opin Pulm Med. 2003; 9: 261-265Crossref PubMed Scopus (56) Google Scholar Occurring particularly in cirrhotic patients with transudative ascitic effusions, known as hepatic hydrothorax, the negative intrathoracic pressure promotes ongoing leakage of plasma and proteins into the pleural space. As the thoracostomy tube continues to drain uncontrolled, the patient’s plasma is siphoned off leading quickly to hypovolemia and shock.3Garcia N. Mihas A.A. Hepatic hydrothorax: pathophysiology, diagnosis, and management.J Clin Gastroenterol. 2004; 38: 52-58Crossref PubMed Scopus (58) Google Scholar It is similar to the hypotension that may occur after large volume paracentesis, except occurring at smaller volumes due to the much more rapid fluid shift from the leakage of capillaries and lymphatics (intra-abdominal pressure is positive while intra-pleural pressure is negative, encouraging further plasma outflow). A hepatic hydrothorax should be managed primarily by aggressive medical management, including sodium restriction and diuretics, but if respiratory distress necessitates thorascentesis, no more than 1.5 L should be removed acutely.2Kinaswetz G.T. Keddiss J.I. Hepatic hydrothorax.Curr Opin Pulm Med. 2003; 9: 261-265Crossref PubMed Scopus (56) Google Scholar, 3Garcia N. Mihas A.A. Hepatic hydrothorax: pathophysiology, diagnosis, and management.J Clin Gastroenterol. 2004; 38: 52-58Crossref PubMed Scopus (58) Google Scholar There are other times when rapid drainage of a massive pleural effusion may be the definitive life-saving therapy. A massive fluid collection under pressure can compress and shift the mediastinum, giving the same clinical picture of a tension pneumothorax: tachycardia, tachypnea, arterial hypotension with jugular venous distension possibly leading to cardiopulmonary arrest.4Pifarre R. Martinez C. Rosell A. Shock and cardiorespiratory arrest secondary to massive pleural effusion.Archivos de Bronconeumologia. 1997; 33: 594-595PubMed Google Scholar Immediate relief of symptoms occurs with rapid pleural drainage reducing the compression of the superior vena cava and pericardium, thereby allowing normal venous return and ventricular filling. This disorder is known to occur after thoracic surgery or trauma if the thoracic duct is disrupted, allowing lymph to rapidly fill the pleural space, and is known as tension chylothorax. The fluid will often have a cloudy, milky appearance consistent with chyle, but it may also be straw-colored and resemble a typical serous effusion.5Karwande S.V. Wolcott M.W. Gay W.A. Postpneumonectomy tension chylothorax.Ann Thorac Surg. 1986; 42: 585-586Abstract Full Text PDF PubMed Scopus (15) Google Scholar, 6Glyn-Jones S. Flynn J. Traumatic tension chylothorax.Injury, Int. J care Injured. 2000; 31: 549-550Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In replyAnnals of Emergency MedicineVol. 49Issue 4PreviewWe thank Dr. Shiber for explaining the risks inherent in hepatic hydrothorax evacuation and for elucidating how tension chylothorax occurs following trauma or thoracic surgery. Full-Text PDF

The usefulness of early laparoscopic surgery for determining a medical treatment plan in severe acute pancreatitis

A 41-year-old woman presented with sudden onset severe epigastric pain. She was diagnosed as having severe acute pancreatitis (SAP) with an APACHE II score of 10, and initially, general supportive therapy was performed. Because the patient's condition kept worsening, early laparoscopic surgery was performed. It revealed swelling, hemorrhagic necrosis of the pancreas, and massive fluid collection in the abdominal cavity. Kocherization and bursectomy were performed for these lesions, and drainage tubes were indwelled. The white blood cell count (WBC) and serum interleukin-6 value prominently improved shortly after the operation, and the WBC count remained at a low level. The patient gradually recovered and was finally discharged 39 days after her initial presentation. To summarize, we performed a successful exploration for SAP, and we found that postoperative continuous lavage effectively eliminated toxic enzymatic exudates in the abdominal cavity and prevent them from circulating. Regarding SAP with peritonitis, early laparoscopic surgery is very useful for determining the pathological extent of the disease and for selecting appropriate treatment options.