ACUTE NECROTIZING PANCREATITIS COMPLICATED BY POSTOPERATIVE PULMONARY EMBOLISM AND ACUTE ACALCULOUS COLECYSTITIS. CASE PRESENTATION WITH LITERATURE REVIEW

Abstract

Introduction. Acute necrotizing pancreatitis accounts for 20-30% of acute pancreatitis and is associated with high rates of morbidity and mortality, caused by a systemic inflammatory response syndrome. Pulmonary thromboembolism in acute pancreatitis is considered a rare complication, and communications dedicated to this subject are sporadic.

Case presentation. We present a case of acute necrotizing pancreatitis complicated postoperatively with pulmonary thromboembolism and acute acalculous cholecystitis. The 56-year-old patient underwent necrosectomy with drainage of the parapancreatic space for acute necrotizing pancreatitis. The immediate postoperative period evolves favorably with the improvement of the patient's general condition and biological constants. On the 13th postoperative day, the general condition worsens suddenly with clinical manifestations of acute cardio-pulmonary insufficiency. Pulmonary thromboembolism is suspected, confirmed paraclinically: Computer Tomography signs for bilateral segmental pulmonary thromboembolism. The source of pulmonary thromboembolism is diagnosed by duplex scanning of the venous system of the lower limbs: recent thrombosis of the deep venous system on the left with intraluminal thrombotic masses, without signs of flotation. Anticoagulant treatment is instituted with a positive effect. On the background of a relatively satisfactory state, on the 28th postoperative day, the clinical and imaging picture of acute acalculous cholecystitis develops, which requires an open cholecystectomy with intraoperative picture of gallbladder gangrene. Favorable postoperative evolution and approximately 1.5 months after admission, the patient is discharged, having improved clinical and paraclinical parameters.

Conclusions. Pulmonary thromboembolism in acute pancreatitis is considered an extremely rare, potentially lethal complication, and early diagnosis of thromboembolism is imperative. Infected acute necrotizing pancreatitis can involve the adjacent organs in the inflammatory process, with the development of unpredictable complications in the postoperative period.