Giant retroperitoneal abscess following necrotizing pancreatitis treated with internal drainage.
BACKGROUND
Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors: alcohol abuse, trauma, biliary stones, and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications. The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon. A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess.


METHODS
A 62-year-old man, with a history of alcohol abuse, was admitted for intermittent abdominal pain, fever, and significant weight loss. Previous medical consultations (laboratory tests, US, CT) confirmed chronic pancreatitis with pseudocyst formation. A new CT depicted a giant retroperitoneal abscess.


RESULTS
After preoperative preparation with antibiotics, laparotomy and internal drainage-longitudinal cystoje-junostomy with Roux-en-Y loop were performed. At the 8th postoperative day the patient was in good condition.


CONCLUSIONS
Giant retroperitoneal abscess is a dangerous pathology with significant mortality and morbidity. Diagnosis strongly necessitates operative intervention in order to evacuate and drain the space. These conditions include one internal drainage (in the GI tract) with the stomach, duodenum, or jejunum, which does not cause early and late GI discomfort and will gradually liquidate the cavity. We propose internal drainage with Roux-en-Y jejunal loop as the only method for accomplishing these conditions in cases of giant retroperitoneal abscesses.
Veltchev
Ludmil Marinov
LM
Department of Liver Diseases and Transplantation, Columbia Presbyterian Hospital, 622 West 168 Street, New York 10032, USA. drlmarinov@yahoo.com
Kalniev
Manol Anastasov
MA
D018784:Abdominal Abscess / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage / Q000379:methods*; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D012187:Retroperitoneal Space; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents