A Case of Severe Acute Pancreatitis with Abdominal Compartment Syndrome and Multiple Intestinal Necrosis

Yoshihiro Moriwaki, Kenichi Yoshida, Shigeru Yamagishi, Satoshi Hasegawa, Koji Kanaya, Toshiro Yamamoto, Mitsugi Sugiyama, Shinju Arata, Seiichiro Iwata^* and Keiichi Watanabe^*

Critical Care and Emergency Center, Yokohama City University Medical Center
Department of Surgery, Yokosuka Hokubu Kyousai Hospital^*

We experienced a case of severe acute pancreatitis (SAP) with abdominal compartment syndrome (ACS) who underwent a decompression laparotomy resulting in multiple surgeries, open wound drainage (OWD), and daily peritoneal lavage. A 51-year-old man was diagnosed as having SAP and was placed on continuous hemodialysis filtration and continuous regional arterial infusion. However, the patient reqired a decompression laparotomy because of ACS, and with a necrotizing infection of the retroperitoneium and multiple intestinal necrosis. The intestinal wall was edematous and thickened; as a result, the wall could not be sutured. We controlled the peritonitis from the continuous leakage of intestinal contents by frequent operation, drainage, necrosectomy, tube jejunostomy, and daily peritoneal lavage. The lost abdominal wall was repaired with a free musclar flap and skin graft. The patient was transferred to another hospital on the 302nd hospital day. ACS is thought to be a surgical indication for acute pancreatitis, and OWD is useful for the management of ACS with peritonitis.

Key words
severe acute pancreatitis, abdominal compartment syndrome, open wound drainage

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
June 25, 2003

To read the PDF file you will need Abobe Reader installed on your computer.