A Case of Extended Necrotizing Pancreatitis Treated Successfully by Direct Retroperitoneal Open-Drainage Method

A case of extended necrotizing pancreatitis complicated with bacterial infection was treated successfully by our new surgical method, direct retroperitoneal open-drainage. A 69-year-old woman complaining of epigastralgia and severe back pain was hospitalized and treated for acute pancreatitis for about a month. Then she developed shock and underwent surgery. The CT findings just before the operation revealed a large amount of necrotic tissue complicated with bacterial infection spreading widely throughout the retroperitoneal space, from the peripancreatic space to the pelvic cacity. We made a long oblique incision from the root of the 12th rib to the anterior superior spina iliaca on the left side of her back to obtain a direct approach to the retroperitoneal space. The necrotic tissue was removed bluntly. The skin and muscle edge of the wound was turned over, and sutured to the skin around the wound. The wound was laid open. The same procedure was performed on her right back one week after that. Lavage and debridement were performed twice a day via these bilateral wounds. The infection in the retroperitoneal space was controlled completely after about one month. Although several surgical treatments for extended necrotizing pancreatitis has been advocated, they all involve trans-peritoneal approaches after laparotomy and may be frequently insufficient for drainage and removal of infectious necrotic tissue spreading throughout the retroperitoneal space. Our new method could achieve adequate drainage for the widespread infectious necrotic tissue in the retroperitoneal space under a minimally invasive operation.