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Abstract : |
The current management guidelines in severe acute pancreatitis call for non-operative treatment as long as there is no evidence of infection. Recently a few reports describing abdominal compartment syndrome in patients with severe acute pancreatitis necessitating decompressive laparotomy were published in the English literature. We describe an additional case of abdominal compartment syndrome in a patient with severe acute pancreatitis successfully treated by decompressive burso-omentostomy. A 42 years old male patient was admitted to our surgical unit, within 48 hours after onset, complaining diffuse abdominal pain, nausea and multiple vomiting. The diagnosis of acute pancreatitis was established based on USG (free fluid in the abdominal cavity and lesser sack, pancreatic edema) and urine amylase level - 1200 g/h/L. Due to his poor condition the patient was admitted to the intensive care unit. During next 48 hours after admission the patient developed intra-abdominal hypertension (35 cm H2O measured transvesically) and abdominal compartment syndrome with multiple organ dysfunction. CT revealed gross pancreatic and retroperitoneal edema accompanied by abdominal distension with massive gas in the gastrointestinal tract. The patient necessitated abdominal decompression and burso-omentostomy was performed, followed by three sessions of lesser sack debridement. Intra-abdominal pressure normalized after surgical decompression and multiple organ dysfunction disappeared. The patient was discharged on 54 postoperative day. His ventral hernia was repaired 6 months later. This case report highlights that severe acute pancreatitis may be associated with intra-abdominal hypertension with clinically significant abdominal compartment syndrome in the early stages of the disease and decompression by burso-omentostomy in absence of infection is one possible solution of this critical situation. Further evaluation on a large patients series is necessary before final conclusion will be reached, regarding the efficacy of laparostomy (burso-omentostomy) in the management of severe acute pancreatitis with abdominal compartment syndrome. , |
