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Management of infected pancreatic necrosis in the setting of concomitant rectal cancer:A case report and review of literature

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World Journal of Gastrointestinal Surgery 2019年第4期11卷 237-246页

作者： kihoon choi David E Flynn Anitha Karunairajah Andrew Hughes Ambika Bhasin Benedict Devereaux Manju D Chandrasegaram Department of Surgery Gold Coast University Hospital Department of General Surgery the Prince Charles Hospital Department of Radiology the Prince Charles Hospital Department of Gastroenterology Royal Brisbane and Women’s Hospital

BACKGROUND Pancreatitis with infected necrosis is a severe complication of acute pancreatitis and carries with it high rates of morbidity and mortality. The management of infected pancreatic necrosis alongside concomitant colorectal cancer has never been described in *** SUMMARY A 77 years old gentleman presented to the Emergency Department of our hospital complaining of ongoing abdominal pain for 8 h. The patient had clinical features of pancreatitis with a raised lipase of 3810 U/L, A computed tomography(CT) abdomen confirmed pancreatitis with extensive peri-pancreatic edema. During the course of his admission, the patient had persistent high fevers and delirium thought secondary to infected necrosis, prompting the commencement of broad-spectrum antibiotic therapy with Piperacillin/Tazobactam. Subsequent CT abdomen confirmed extensive pancreatic necrosis(over 70%). Patient was managed with supportive therapy,nutritional support and gut rest initially and improved over the course of his admission and was discharged 42 d post admission. He represented 24 d following his discharge with fever and chills and a repeat CT abdomen scan noted gas bubbles within the necrotic pancreatic tissue thereby confirming infected necrotic pancreatitis. This CT scan also revealed asymmetric thickening of the rectal wall suspicious for malignancy. A rectal cancer was confirmed on flexible sigmoidoscopy. The patient underwent two endoscopic necrosectomies and was treated with intravenous antibiotics and was discharged after 28 *** 1 wk post discharge, the patient commenced a course of neoadjuvant radiotherapy and subsequently underwent concomitant chemotherapy prior to undergoing a successful Hartmann's procedure for treatment of his colorectal *** This case highlights the efficacy of endoscopic necrosectomy, early enteral feeding and targeted antibiotic therapy for timely management of infected necrotic pancreatitis. The prompt resolution of pancreatitis

关键词： Necrotizing pancreatitis Rectal cancer Enteral nutrition Endoscopy Case report

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