Necrosectomy with open drainageで救命しえた重症急性膵炎の1例

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  • SEVERE ACUTE PANCREATITIS SUCCESSFULLY RECOVERED WITH NECROSECTOMY WITH OPEN DRAINAGE

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A 41-year-old man was admitted to the hospital with severe acute pancreatitis. Abdominal CT revealed that pancreatic inflammation developed from the peripancreatic region to root region of the transeverse-mesenterium, retroperitoneal and left posterior space. At first, he was successfully managed by conservative treatment under early intensive cares. Despite of such 10 days' cares, the patient was diagnosed with infected pancreatic necrosis and operated on by necrosectomy with closed lavage. Postoperative course was uneventful, but, 2 weeks later, other intensive cares such as steroidal pulse therapy, continuous intraarterial infusion of protease inhibitor and antibiotics and continuous hemodiafiltration therapies, were respectively tried for recurrent pancreatitis, hyperdynamic state and adult respiratory dystress syndrome. These therapies were successful. There after, intraabdminal draiange became poor and intraabdominal residual necrotic tissues and a pancreatic psuedocyst were infected again with fever. The patient underwent a necrosectomy with open drainage to be thoroughly put into debridement of open wound under sedation in the ICU. The patient is completely recovered without any complications. We think that necrosectomy with open drainage is one of useful therapies for intractable severe acute pancreatitis with wide spread inflammation to the retroperitoneal and pararenal space.

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