Pneumoretroperitoneum Caused by Severe Acute Pancreatitis

DOI 3 Citations 14 References
  • Yamamoto Takatsugu
    Surgery, Ishikiri Seiki Hospital
  • Uenishi Takahiro
    Surgery, Ishikiri Seiki Hospital
  • Ichikawa Tsuyoshi
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Hai Seikan
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Ogawa Masao
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Sakabe Katsu
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Tanaka Shogo
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Tsukamoto Tadashi
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Kubo Shoji
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
  • Ohno Koichi
    Surgery, Ishikiri Seiki Hospital
  • Hirohashi Kazuhiro
    Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine

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Other Title
  • 後腹膜気腫を併発した重症急性膵炎の１例

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Abstract

A 76-year-old Japanese man with idiopathic abdominal pain and fever was found in Computed tomography (CT) of the abdomen to have pneumoretroperitoneum. Abdominal ultrasonography (US) did not show either stones or stenosis of the biliary tract. Serun biochemical examination demonstrated high amylase, bilirubin, and C reactive protein. Limited to several preoperative diagnoses, we conducted gastrointestinal endoscopy before exploratory laparotomy. Endoscopy showed erosive gastritis and no perforated lesion on the upper gastrointestinal tract, yielding a preoperative diagnosis of pancreatitis or perforation of colon. We then conducted laparotomy. The transverse mesocolon adjacent to the pancreas head was dark, suggesting necrosis of the pancreas head and mesocolon, necessitating segmental transverse colostomy and drainage of the retroperitoneal space next to the pancreas head. After intensive care for severe pancreatitis, respiratory failure, bacterial site infection, and disseminated intravascular coagulation, the patient recovered and was discharged three months after surgery. Different diseases cause pneumoretroperitoneum, and the primary cause may be difficult to find. In some cases of pneumoretroperitoneum, digestive tract endoscopy may aggravate pneumoretroperitonitis. Our case, however, suggests that preoperative gastrointestinal endoscopy contributes to swift, accurate surgical treatment because most cases of pneumoretroperitonitis require surgery.

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