Supurated pancreatic pseudochist: clinical case

Abstract

Introduction: Pancreatic pseudocyst (PP) is one of the evolutionary complications of severe acute pancreatitis. The reported incidence is 2-15%, PP suppuration is reported in 1.6 - 4.5%. The surgical approach to suppurative PP remains a current issue. Purpose: Description of the clinical case illustrating a variant of the surgical attitude in suppurative PP. Material and methods: Woman 72 years old, with a history of breast CR T3N1M0 operated, state after 2 courses of chemotherapy, hypertension gr. III, ischemic heart disease, angina pectoris IC II NIHA, is hospitalized primarily for severe acute pancreatitis after chemotherapy. Treatment with evolution in PP. Readmitted over 3 months for severe epigastric pain, multiple vomiting and fever -38˚ C. Results: Investigations: Le - 18.0x10 9 / l, blood amylase - 116 u / e, urine amylase -1876 u / e. USG - dilimited liquid formation with a diameter of 15 cm with inhomogeneous content, located in the body and pancreatic tail. Surgical treatment: paracostal laparotomy, opening and evacuation of pus and necrotic masses, bilateral bilumen drainage. Postoperative: by fractional lavage drains with antiseptic and anti-enzyme solutions. The drain on the right removed after 16 days, on the left - 45 days. USG control did not report any remainding cavities. In evolution - insulin-dependent secondary diabetes. Conclusions: USG has a major important in the diagnosis and selection of the approach to the patient with suppurative pancreatic pseudocyst. Regardless of the contemporary arsenal of minimally invasive treatment methods, traditional surgery has indications in suppurated PP in correlation with the size, location of the formation and the presence of necrotic tissue content.