Pancreatitis aguda grave de origen biliar con secuelas: necrosis pancreática, pseudoquiste y trombosis de la vena esplénica
Mochón Benguigui S ¹ , Navarro Freire F ²
(1) Student Intern, Department of surgery and surgical specialties, Faculty of Medicine, University of Granada, Spain.
(2) Tenured Professor on General and Digestive system surgery, Department of surgery and surgical specialties, Faculty of Medicine, University of Granada, Spain.
40 year old male with ulcerative gastritis, cholelithiasis and severe acute pancreatitis with long-term hospital stay, requiring tracheal intubation and tracheotomy. Chyloperitoneum, cholelithiasis and pancreatic pseudocyst with a 90% necrosis without active bleeding were found during surgery. Cholecistectomy, washing and intracavitary necrosectomy, stitching of the small vascular intracystic stump, Roux-en-Y cystojejunostomy, draining of the chyloperitoneum and of the cavity were performed. Chylous ascites persisted and was treated with octeotride, diuretics and fat-free diet supplemented with medium-chain trigliyerides, proteins and vitamins. However, sequels remained including: recurrent acute pancreatitis, splenic
vein thrombosis and left portal hypertension. As the patient was not diabetic and the platelet count was 140000 cells/mm3 splenectomy or expectant monitoring were posed as possible choices. The interest of the case is rooted in the diagnosis, treatment and evolution of the chylous ascites, 90% pancreatic necrosis, pseudocyst and splenic vein thrombosis, as well as the repeated admissions.
Keywords: severe acute pancreatitis, chylous ascites, pancreatic pseudocyst, left portal hypertension, surgery.
Palabras clave: Pancreatitis aguda grave, ascitis quilosa, pseudoquiste pancreático, hipertensión portal izquierda, cirugía.