Severe acute pancreatitis of gallblader origin with sequels: pancreatic necrosis, pseudocyst and splenic vein thrombosis
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Archivos de Medicina Universitaria
Materia
Severe acute pancreatitis Chylous ascites Pancreatic pseudocyst Left portal hypertension Surgery Pancreatitis aguda grave Ascitis quilosa Pseudoquiste pancreático Hipertensión portal izquierda Cirugía
Date
2016Referencia bibliográfica
Mochón Benguigui, Sol; Navarro Freire, Francisco. Severe acute pancreatitis of gallblader origin with sequels: pancreatic necrosis, pseudocyst and splenic vein thrombosis. AMU. 2016; 4: 37-41
Abstract
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.
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