Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico

Authors

  • Pedro A. Alvarado-Bahena Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Enrique Chavez-Serna Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Jonatan Salgado-Vives Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Uraik F. Hernandez-Bustos Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Dante A. Saldivar-Vera Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Landy L. Mendoza-Morales Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro
  • Pedro A. Espinosa de los Monteros-Moranchel Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro, México

DOI:

https://doi.org/10.18203/2320-6012.ijrms20204446

Keywords:

Acute pancreatitis, Pancreatic necrosis, Acute necrotizing, Surgery, Disconnected pancreatic duct syndrome, Hypertriglyceridemia

Abstract

Walled-off pancreatic necrosis is defined as a necrotic collection with a defined wall, which generally occurs in 15% of patients in the fourth week after acute pancreatitis. Actually, open surgery is reserved for selected cases, with minimally invasive treatments such as image-assisted percutaneous drainage or endoscopic ultrasound being the procedures of choice. However, in developing countries the open approach continues to be an effective therapeutic alternative. We present the case of a 47-year-old male patient with no significant history who developed severe acute pancreatitis secondary to hypertriglyceridemia and who later developed walled-off pancreatic necrosis as a late complication. As a treatment, a debridement of the necrotic tissue with marsupialization was performed using the bradley III technique, secondary to the procedure, a pancreatic fistula was developed. After 8 weeks of hospitalization, in which he had a favourable response to surgical treatment, with spontaneous closure of the fistula without complications. Surgical management of late complications of acute pancreatitis remains controversial. Although minimally invasive procedures are the first option nowadays, in developing countries, open necrosectomy remains a good option for the treatment of these types of complications.

Author Biographies

Pedro A. Alvarado-Bahena, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro

Department of General Surgery, General Surgery Resident

Enrique Chavez-Serna, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro

Department of General Surgery, General Surgery Resident

Jonatan Salgado-Vives, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro

Department of General Surgery, General Surgery Resident

Uraik F. Hernandez-Bustos, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro

Department of General Surgery, General Surgery Resident

Dante A. Saldivar-Vera, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro

Department of General Surgery, General Surgery Resident

Pedro A. Espinosa de los Monteros-Moranchel, Department of General Surgery, Regional General Hospital, Mexican Institute of Social Security, Queretaro, México

Department of General Surgery, Head of the Parenteral Nutrition Division.

 

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Published

2020-10-28

How to Cite

Alvarado-Bahena, P. A., Chavez-Serna, E., Salgado-Vives, J., Hernandez-Bustos, U. F., Saldivar-Vera, D. A., Mendoza-Morales, L. L., & Espinosa de los Monteros-Moranchel, P. A. (2020). Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico. International Journal of Research in Medical Sciences, 8(11), 4158–4161. https://doi.org/10.18203/2320-6012.ijrms20204446

Issue

Section

Case Reports