The case of the multistage treatment of acute pancreatitis using a variety of minimally invasive techniques

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Abstract

Treatment of acute pancreatitis and infectious complications is a complex multidisciplinary task. The use of traditional surgical procedures for the rehabilitation of foci of pancreatogenic infection often aggravates the course of the disease, leads to the development of postoperative complications, does not improve the results of treatment. On the contrary, the use of minimally invasive techniques avoids additional surgical injury. The case of stage treatment of acute pancreatitis and its purulent-septic complications with the use of minimally invasive technologies is presented to the readers.

About the authors

Sergey Y. Ivanusa

S. M. Kirov Military Medical Academy

Author for correspondence.
Email: koptata@mail.ru
SPIN-code: 8752-1600

M. D., D. Sc. (Medicine), Professor, the Head of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Maksim Lazutkin

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru
SPIN-code: 9364-8068

M. D., D. Sc. (Medicine), Deputy Head of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Dmitriy Shershen

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru
SPIN-code: 2531-5640

M. D., Ph. D. (Medicine), Senior Lecturer of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Anton Chebotar

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru
SPIN-code: 5923-9859

Major of Medical Service, teacher of the 2nd faculty

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

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2. Fig. 1. CT scan of the abdominal cavity of patient M. from 21.09.2017 (1st day of illness)

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3. Fig. 2. CT scan of the abdominal cavity of patient M. from 29.09.2017 (8th day of illness)

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4. Fig. 3A - Endosonogram of the fluid accumulation of the omental bursa

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5. Fig. 3B - cystonasal drainage in the cavity of the omental bursa

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6. Fig. 3. Stages of cystonasal drainage of fluid accumulation of the omental bursa (13th day of illness). B - intraoperative fistulography

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7. Fig. 4. Fistulogram on the 2nd day after cystonasal drainage of the OZhS of the omental bursa (14th day of illness)

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8. Fig. 5A is a schematic diagram of omental bursa re-draining with stent placement

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9. Fig. 5B - intraoperative radiograph

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10. Fig. 5. Redraining of the omental bursa and control X-ray contrast study (71st day of illness). B - control fistulography on the 6th day after repeated drainage of the OZhS of the omental bursa

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11. Fig. 6. Abscess of the retroperitoneal space in the region of the mesenteric root of the small intestine. Abdominal CT cavity of patient M. from 19.10.2018 (28th day of illness)

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12. Fig. 7. Stages of the operation of laparoscopic drainage of the abscess of the mesenteric root of the small intestine (33 days of illness). A - view of the mesentery of the small intestine during laparoscopy; B - endosonogram of the mesenteric root abscess of the small intestine; B - the abscess was opened, liquid pus with sequesters was obtained; D - drainage is installed in the abscess cavity

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13. Fig. 8. CT of the abdominal cavity of patient M. from 10.11.2017 (51st day of illness)

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14. Fig. 9A - X-ray - endoscope and cystonasal drainage loops in the stomach

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15. Fig. 10. Removed from the stomach cystogastric stent, drainage type "double Pig-Tail", sequesters

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16. Fig. 11. Control X-ray contrast study on the 56th day of illness. A - roentgenofistulography; B - communication scheme of cavities

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17. Fig. 12. Endoscopic picture during planned sanation endoscopy on the 56th day of the disease

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18. Fig. 13. Stages of the operation to remove the stent from the lumen of the small intestine (91st day of illness). A - X-ray of organs the abdominal cavity, on which the stent is defined in the projection of the small intestine; B - inflammatory infiltrate and a loop of the small intestine at the site of the stent; B - macroscopic preparation of the removed loop of the small intestine; D - a remote section of the small intestine on a cut, in the lumen of a cystogastric stent

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Copyright (c) 2020 Ivanusa S.Y., Lazutkin M., Shershen D., Chebotar A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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