Agüero MAM, Hernández CJL, Larrondo MH

Language: Spanish
References: 9
Page: 1-9
PDF size: 264.70 Kb.

ABSTRACT

A case is presented of a 61-year-old male patient, of mixed race and from urban origin, with a history of essential arterial hypertension diagnosed 10 years ago and with irregular treatment, and myocardial infarction two years ago. He was referred from a provincial hospital, where he remained for 26 days with a diagnosis of acute necrotizing pancreatitis. Two days before admission to our center, he presented fever of 39ºC, vomiting and recurrence of abdominal pain located in the epigastrium, which was very intense. Complementary tests done on admission show leukocytosis (23,000 cells/mm3, with deviation to the left), normocytic and normochromic anemia. The ultrasonography performed shows a unique collection, well defined, located between the body and the tail of the pancreas, with heterogeneous content. Severe necrotizing pancreatitis is diagnosed and, as a local complication, an infected second encapsulated necrosis. The patient is admitted to the Intensive Care Unit. Antimicrobial treatment is given. Under ultrasonographic vision, percutaneous drainage is inserted in a declining area of the necrotic, encapsulated and infected second peripancreatic collection, with the intention of evacuating this and avoiding open necrosectomy.
Conclusion: Ultrasound-guided percutaneous drainage of the encapsulated and infected necrotic collection was sufficient to evacuate the contents and avoid open necrosectomy. This allowed taking samples for microbiological studies, in addition to facilitating the favorable evolution of the patient and his early transfer outside the Intensive Care Unit.

REFERENCES

1. Banks PA, Bollen TL, Dervenis C, et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: Revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. Disponible en http://www.ncbi.nih.gov/gut.bmj.com/content/62/1/102

2. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014;12:349-357.

3. Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction Score: A reliable descriptor of complex clinical outcome. Crit Care Med. 1995;23:1638-52.

4. Yang CJ, Chen J, Phillips AR. Predictors of severe and critical acute pancreatitis: a systematic review. Digestive and Liver Disease. 2014;46:446-51.

5. Gurusamy KS, Belgaumkar AP, Haswell A, et al. Interventions for necrotising pancreatitis. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD011383.DOI: 10.1002/14651858.CD011383.pub2.

6. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 -. Record No. T127664, Acute Pancreatitis; [updated 2018 Dec 04, cited 20/01/2019]. Available from https://www.dynamed.com/topics/dmp~AN~T127664.

7. Marin HK, Warren I. The Washington Manual of Critical Care. 3rd ed. Philadelphia: Wolters Kluwer; 2018. p. 924.

8. Tenner S, Baillie J, De Witt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: Management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15.

9. Koutroumpakis E, Wu BU, Bakker OJ, et al. Admission hematocrit and rise in blood urea nitrogen at 24 h outperform other laboratory markers in predicting persistent organ failure and pancreatic necrosis in acute pancreatitis: A post hoc analysis of three large prospective databases. American Journal of Gastroenterology. 2015;110:1707-16.