Minimally Invasive Surgery for Necrotizing Pancreatitis: A Case Report

作     者：Néstor Veriel Méndez Huerta Luis Fernando Zorrilla Núñez Noelia Obregón Gaxiola César Jair Treviño Arizmendi Gerardo Iván Muñoz Morales Marco Alejandro Arizmendi Villarreal Pamela Denisse Valdez Navarro Marco Antonio Hernández Guedea Gerardo Enrique Muñoz Maldonado Néstor Veriel Méndez Huerta;Luis Fernando Zorrilla Núñez;Noelia Obregón Gaxiola;César Jair Treviño Arizmendi;Gerardo Iván Muñoz Morales;Marco Alejandro Arizmendi Villarreal;Pamela Denisse Valdez Navarro;Marco Antonio Hernández Guedea;Gerardo Enrique Muñoz Maldonado

作者机构：Service of General Surgery Hospital Universitario “Dr. José Eleuterio González” Universidad Autónoma de Nuevo León Monterrey México 

出 版 物：《Surgical Science》 (外科学（英文）)

年 卷 期：2024年第15卷第9期

页      面：514-521页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Necrotizing Transgastric Pancreatic Necrosectomy Pancreatitis Case Report 

摘      要：Introduction : Necrotizing pancreatitis management is complex and varies significantly among clinicians. Minimally invasive approaches like transgastric necrosectomy via laparoscopy are emerging as effective treatment options. This case report underscores the technique’s efficacy, clinical outcomes, and role in reducing complications. Clinical Observation: A 59-year-old male with a history of smoking and alcoholism presented with severe abdominal pain, nausea, and vomiting. Over the following weeks, he developed symptoms including asthenia, weight loss, and melena. Diagnostic workup revealed severe anemia and Balthazar E necrotizing pancreatitis, with significant intra-abdominal fluid collections and signs of infection. After initial conservative management, the patient underwent transgastric necrosectomy via laparoscopy due to deteriorating clinical status. The procedure involved removing necrotic tissue and performing a cystogastroanastomosis and jejunostomy. Postoperative care included fasting, parenteral nutrition, broad-spectrum antibiotics, and enzymatic replacement. The patient recovered well, with reduced necrotic tissue on follow-up imaging, and was discharged twelve days post-surgery [1]. Conc lusion: Transgastric necrosectomy by laparoscopy is a valuable first-line surgical option for patients with symptomatic necrotizing pancreatitis, particularly in cases without prior interventions. This minimally invasive technique helps reduce major complications and mortality, offering a less invasive alternative to traditional open necrosectomy. The multidisciplinary approach and careful postoperative management were crucial to the patient’s favorable outcome. The case highlights the potential of transgastric necrosectomy as an effective treatment strategy in managing complex pancreatitis cases, including those with associated duodenal perforation [2].