Video-assisted retroperitoneal debridement for infected retroperitoneal fat necrosis following laparoscopic distal pancreatectomy.
Katsuya Ami, Keiko Kamei, Masaya Nakano et al.
✦ AI-curated · Sources linked
Case in brief
An 81-year-old woman developed abdominal pain after laparoscopic distal pancreatectomy for pancreatic tail adenocarcinoma. CT showed progressive fluid collection around the pancreatic stump and inflammatory extension into the retroperitoneum. Despite temporary improvement with fasting and antibiotics, extensive infected retroperitoneal fat necrosis developed. CT-guided drainage did not provide adequate source control because the debris was highly viscous, so surgical necrosectomy was performed and a retroperitoneal access route established. Video-assisted retroperitoneal debridement removed 61 g of necrotic fatty tissue; inflammatory markers improved, and she was discharged in good condition.
What made this case unusual
VARD, established for infected necrotizing pancreatitis, was used in a postoperative setting for infected retroperitoneal fat necrosis after distal pancreatectomy, after percutaneous drainage proved inadequate because of viscous debris.
Diagnostic / clinical pearl
When postoperative infected retroperitoneal necrosis contains viscous debris that prevents adequate percutaneous drainage, a step-up approach incorporating VARD may provide source control.