Pancreatitis necrotizante post - traumatico

Abstract

Acute pancreatitis is the main topic of study of this degree work, being its frequent etiology the biliary lithiasis, followed by alcohol consumption, drug ingestion, and hypertriglyceridemia and as an infrequent cause the pancreatic trauma, taking into account the anatomical situation of this organ zwhich is retroperitoneal located. Pancreatic necrosis occurs in 10 to 20% of patients with acute pancreatitis. This case is about a 21-year-old male patient, without significant pathological history who suffered a traffic accident causing a closed abdominal trauma that evolved into a necrotizing pancreatitis which was resolved in several surgical times. In its therapeutic approach, laboratory tests and imaging studies were performed and because its clinic-status it was decided to perform an exploratory laparotomy finding hemoperitoneum and a lesion in the spleen, for which a raffia was made and a Jackson Pratt drainage was placed. During the first post-operative days, an Abdominal Tac was performed, finding free fluid in the left subdiaphragmatic space in front of the left lobe of the liver. It was decided to perform an exploratory re-laparotomy, finding pancreatic fluid, areas of saponification in greater and lesser omentum, phlegmon formed by the stomach, minor omentum and colon, transverse mesocolon lesion involving the body of the pancreas, which is affected with necrosis, thrombosed vessels with gelatinous fluid discharge; it is carried out a necrosectomy, abdominal cavity lavage, tubular drainage placement in pancreatic necrotic areas. The objective of this case was to show that necrotizing pancreatitis was a surgical finding in this patient, and to encourage the suspicion of this condition in a pancreatic trauma secondary to a traffic accident.