Multiple postnecrotic infected pancreatic cysts. Induced pancreatectomy

Background. We present a case report of successful emergent surgical treatment of a patient with chronic pancreatitis complicated by perforated postnecrotic cysts and diffuse peritonitis.

Case report. The male aged 52 presented with a long-term persistent chronic pancreatitis (pain form) which developed following pancreatic necrosis. Perforation of postnecrotic cysts and duodenal fistula induced peritonitis. The indication for pancreatoduodenectomy was cystic transformation of the pancreas and complicated intraoperative situation that met the criterion of “Technical problems”: the total lesion of the pancreas and parapancreatic tissues, formation of postnecrotic cysts, communication with the upper horizontal branch of the duodenum (fistula) and evacuation into the free abdominal cavity. The cysts communicated with the major pancreatic duct. Pancreatectomy under such conditions was reasonable. The first stage of surgery included distal resection of the pancreas, abdominal debridement, and compression hemostasis. After improving the patient’s condition, the pancreatoduodenal complex was removed in programmed relaparotomy. We formed cholecystoenteroanastomosis because of the small diameter of the choledochus. Function of gastrointestinal tract restored shortly after operation due to enteral nutrition through a nasointestinal probe, pancreatic enzymes from the first day, and early activation of the patient.

Conclusion. Pancreatectomy in chronic pancreatitis is technically difficult. There is a high probability of damage to large vessels and significant blood loss. Correction of metabolic disorders in the postoperative period is possible due to the targeted use of modern medicines.

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