Retroperitoneal Lavage in the Treatment of Infectious Necrotizing Pancreatitis -Report of a Case-

Toshiya Ito, Kenya Chiba*, Keiji Inoue**, Kouichi Motoshima**, Takashi Yamaguchi*, Tsukasa Tsunoda**, Takashi Kanematsu**

The School of Allied Medical Sciences, Nagasaki University
*Nishi-isahaya Hospital
**Second Department of Surgery, Nagasaki University School of Medicine

The patient was a 50-year-old man who visited our hospital with abdominal pain and fever as the primary complaints. A diagnosis of severe acute pancreatitis was made by various examinations, and infusion therapy, chemotherapy and hyperbaric oxygen therapy were administered in the ICU. As a result, the general condition and clinical laboratory findings improved rapidly. However, as abdominal pain and high fever recurred about three weeks after admission, with a WBC of 15,500, strongly positive CRP, and aggravation of CT findings, a diagnosis of infectious pancreatic necrosis was made, and laparotomy was carried out. The operation consisted of removal with the fingers of lysed infected necrotic tissues in the retroperitoneum including the pancreas by the retroperitoneal route, followed postoperatively by continuous retroperitoneal lavage, which was maintained for eight weeks. Staphylococcus aureus was detected in the necrotic foci. This operation was a new procedure. Its objective was elimination of infectious necrotic materials and biologically active materials that may be produced after an operation as well as debridement of infectious necrotic foci in the retroperitoneum. The procedure therefore promotes wound healing and improved the general condition.

Key words
infectious necrotizing pancreatitis, retroperitoneal lavage

Reprint requests
Toshiya Ito The School of Allied Medical Sciences, Nagasaki University
7-1 Sakamoto-machi, Nagasaki, 825 JAPAN

Accepted
May 13, 1992

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