Step-up approach and video assisted retroperitoneal debridement in @entity788 : A case complicated by retroperitoneal @entity548 and XXXX .

@entity788 @entity295 @entity548 @entity39 @entity8678 @entity694
INTRODUCTION: @entity788 carries a high mortality and necessitates intervention to achieve @entity295 control. The surgical strategy for proven infected @entity39 has evolved, with abandonment of open necrosectomy to a step-up approach consisting of percutaneous drains and @entity8678 ( @entity8678 ). We present a case that underwent @entity8678 complicated by @entity548 and @entity694 and describe its management. PRESENTATION OF CASE: A 38 year-old male with acute @entity788 developed @entity788 . Initial treatment was by percutaneous drainage under radiological guidance and intravenous antibiotics. The @entity39 was then debrided using gasless laparoscopy through a mini-incision. Post-operatively, he developed @entity548 which was controlled with angioembolisation. He also developed a descending @entity694 which was treated with laparotomy and defunctioning loop ileostomy. He recovered and subsequently had his ileostomy closed twelve months later. The @entity694 recurred and was treated with endoscopic clips and histoacryl glue injection and finally closed. DISCUSSION: Step-up approach consists of the 3 D's: Delay, drain and debride. @entity8678 is recommended as it is replicable in general surgical units using standard laparoscopic instruments. Bleeding and colon perforation are potential complications which must have multi-disciplinary input, aggressive resuscitation and timely radiologic intervention. Defunctioning ileostomy is recommended to control @entity295 in @entity694 . Novel fistula closing methods using endoscopic clips and histoacryl glue are potential treatment options. CONCLUSION: Step-up approach and @entity8678 is the new paradigm to treat @entity788 . Complications of @entity548 and @entity694 are uncommon and require multi-disciplinary management.
