Minimally Invasive Surgical Step-Up Approach In Patients With Infected Necrotizing Pancreatitis A Case Report And Review Of The Literature

Background: About 30% of severe acute pancreatitis patients may combined with infectious necrosis 2 weeks after the onset,and can often cause sepsis.If antibiotic treatment fails,it will develop to septic shock.Previous laparotomy may have a higher incidence of complications and longer hospital stays.The step-up of minimally surgery we use at present is provided good effect.Objective: To introduce a case of infected necrotizing pancreatitis.There is a typical history of severe acute pancreatitis and features of necrosis combined with infection.Give them treatment which is followed the latest international guidelines for severe acute pancreatitis.Methods: We use the case of 45-year-old male patient as an example to demonstrate the progression and diagnosis of infected necrotizing pancreatitis.The patient suffered a sudden abdominal pain and was diagnosed as severe acute pancreatitis,was admitted to ICU immediately.We treat him following the procedures of the international guideline.Aiming at the infectious necrosis occurred later,we use a stepped diversified minimally invasive surgical treatment.Discussion: The clinical manifestations of acute pancreatitis are often abrupt abdominal swelling pain.It may lead to multiple organ failure,which is rapidly progress,leading a high mortality in the acute phase.After the diagnosis,we should use multi-disciplinary combination of comprehensive treatment,such as active goal-oriented liquid resuscitation,which including drugs and surgical intensive care.Later,there was severe sepsis during the infection period,there was no significant effect of antibiotic treatment and the removal of infectious necrosis was needed.Based on the diversified minimally invasive treatment method,we use the technology of ultrasonic percutaneous drainage,choledochoscope and percutaneous nephrolithotomy to perform drainage and debridement.We established a diversified minimally invasive surgical treatment.We did not need to open the abdomen.We expanded the sinus tract at the three drainage catheters.An initial application of the biliary tract was performed.We continued to dilate the sinus tract to 1 cm later.Percutaneous nephrolithotomy was used to remove necrosis.Conclusion: For the infected necrotizing pancreatitis,when antibiotics are ineffective,a diversified ascending staircase minimally invasive surgical treatment can be used.