“Necrosis pancreática secundaria a pancreatitis aguda grave”

Abstract

Pancreatic necrosis is considered one of the main local complications associated with severe or severe acute pancreatitis and its presence only indicates greater severity, which can cause a high mortality rate if it is not diagnosed and treated in time given that the complications overlapping can further worsen the results.

The present case is about a male patient A 67-year-old male patient, with no personal or significant family medical history, who goes to the Ambato social insurance hospital on May 4, referred to the city of Puyo, for presenting abdominal pain for 19 days of great intensity, sudden onset, located in mesograstrium that is not irradiated so it goes to Basic Hospital of Puyo where it remains for 16 days for a picture compatible with severe pancreatitis in treatment with surgery floor care presenting deterioration general with poor evolution so open cholecystectomy is performed after which requires intensive care for 6 days plus subsequent recovery in the surgery floor until today that is assessed and referred to the Ambato social insurance hospital for ERCP and treatment of clinical picture. With echo reporting the intra and extrahepatic bile ducts without 0.7 mm ductile dilation. Gallbladder of thickened walls 4mm, with several calculations inside. And TAC simple and contrasted 30% necrosis of the pancreas liquid collection in head + liquid peripancreatic and perihepatic.

Patient admitted to the surgery service with diagnosis of severe pancreatitis plus peripancreatic necrosis and choledocholithiasis, to perform ERCP. Presenting an unfavorable evolution, nephrology is interconsultated by laboratory analytical values reporting chronic renal failure, which does not prevent scheduled surgery (ERCP) but the patient adds generalized jaundice, with oxygen desaturation, ERCP is not performed due to obstruction When the endoscopic approach was caused by weight compression at the time of the procedure, an exploratory laparotomy was performed, finding plasma at the level of the gallbladder and fistulous tract difficult to identify, plus head and tail necrosis of the pancreas. Present for what is treated in the intensive care unit.