Title: Severe Acute Pancreatitis Presenting As Appendicular Perforation- An Unusual presentation
Authors: Sudhansu Sekhar Sutar, Ranjit kumar Pati, Prasanta Kumar Dass, Debasis Das, Madhusmita Jit
DOI: http://dx.doi.org/10.18535/jmscr/v4i4.20
Pancreatic & Peripancreatic fluid collection is a common complication of severe Acute Pancreatitis. But rarely it can lead to collections at remote sites in peritoneal, retroperitoneal, mediastinal or inguinoscrotal region and manifesting rare presentations. Here is a case of a non alcoholic, non diabetic male, presented with abdominal pain, localized at right iliac fossa with rebound tenderness & features of peritonism. Ultrasonography of abdomen & pelvis shows moderate pelvic collection with internal echos & probe tenderness at right iliac fossa. Patient was diagnosed as a case of Appendicular perforation. On Laparotomy the case was diagnosed as severe acute pancreatitis with secondary/ reactionary appendicitis with pancreatic ascitis, peri pancreatic & pancreatic parenchymal necrosis & pelvic retroperitoneal collection in right iliac fossa extending to the base of appendix. The patient was managed with appendicectomy, draining of pelvic & retroperitoneal pelvic collection, debridement of necrotic fissure in pelvis in right iliac fossa towards right psoas muscle, debridement of patchy necrotic tissue over small bowel mesentery. Thorough irrigation, lavage & suctioning of necrotic & slaughed area on pancreas & peripancreatic tissue had also been done. Key words: Acute Pancreatitis, Appendicular perforation. 1. Molmenti EP et al- Anatomy of retroperitoneum: observation of distribution of pathological fluid collection. Radiology – 1996. 2. Ishkawa.K et al- Classification of AC. Pancreatitis based on retroperitoneal extension. Radio/2006. 3. IAP / APA. Evidence based guideline for management of AP. 4. BJM. Acute pancreatitis Dec.7.2015. 5. Way LW. Dohrty G.M chapter-27. Pancrease in current surgical diagnosis & treatment. 11th ed.2003. 6. Nihon Rinsho .2004 Nov. 62 pubmed. Indication for & efficiency of peritoneal lavage in SAP. 7. Robert Caronne etal. Clinical effect of Laparotomy with perioperative peritoneal lavage. 8. Hitora M.Nozawa F etal- Relationship between plasma cytokine concentration & multi organ failure in patient with Acute Pancreatitis. Pancrease 2000-pubmed. 9. U.K guideline for management of AC. Pancreatitis Gut-2005. Abstract
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