2017, Number 3-4
Laparoscopic approach of an infected pancreatic pseudocyst, with a Roux-en-Y cystojejunostomy in a patient with a gastric sleeve. Case report
Pérez PY, Arcos VB, Morales MVI, Campuzano VCS
Full text
Language: Spanish
References: 6
Page: 133-137
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ABSTRACT
Introduction: The incidence of a pancreatic pseudocyst is low, approximately 0.5 to 1/100,000 adults per year, having a success rate by a laparoscopic approach with an internal bypass of 92 to 100%. We present the first case of a fully laparoscopic internal shunting of an infected pancreatic pseudocyst in a post-bypass patient at the ISSEMyM Toluca Medical Center. Clinical case: This is a 30 years old female with a history of a gastric sleeve due to obesity. Some years later, she is hospitalized in the intensive care unit with the diagnosis of severe biliary pancreatitis with a Balthazar E category, managed conservatively and being discharged after improvement. Six days after her discharge presented with abdominal pain and fever, therefore she returned to this institution and a new CT scan was then performed. A pancreatic pseudocyst of 10.45 × 5.06 × 5.17 cm with heterogeneous content was observed. Then was requested the assessment of interventional radiology services. They did not consider it a candidate for drainage, then the endoscopy service was consulted and they gave her an extended surgical date. When pain, fever, leukocytosis, and thrombocytopenia increased at the 5th day of hospitalization, an emergency laparoscopic surgical approach was decided. A pancreatic pseudocyst was found of approximately 15 × 15 × 10 cm, draining 850 mL of purulent and necrotic material, sent for culture. A cystoejejunostomy (Roux-en-Y) at 50 cm from the angle of Treitz and laparoscopic cholecystectomy were performed with a surgical time of 300 min and 100 mL of surgical bleeding. The culture report of the pseudocyst material was E. coli. She was discharged from the hospital after improvement on the ninth day and completed her antibiotic treatment. Later, she’s followed up at the outpatient clinic with an adequate post-surgical evolution, the laboratory test was within normal parameters and a CT scan without recurrence of the pseudocyst. Conclusion: The laparoscopic approach is feasible in cases of infected pseudocysts, it was safe and also allowed us to perform lavage, internal drainage, cholecystectomy and a cystojejunostomy in a surgical time with the advantages of minimal access surgery and continuous drainage.REFERENCES