2010 Volume 43 Issue 1 Pages 55-60
A severely obese 30-year-old male (BMI 41) weighing 120 kg and referred based on a diagnosis of severe acute pancreatitis was found in computed tomography (CT) to have bilateral hydrothorax, unclear pancreatic parenchyma, and exudate spreading to the posterior pararenal spacer (Grade IV). He also had SIRS and acute circulatory failure. On hospital day 4, persistent inflammatory reactions and a CT finding of pancreatic-head necrosis were noted. Based on a diagnosis of infectious pancreatic necrosis, he underwent necrosectomy. It was difficult to close the abdominal wall because of intestinal and tissue edema. Postoperatively, we attached a vacuum storage bag to the abdominal wall by a zipper. The planned necrosectomy, accompanied by intraperitoneal lavage, was continued to remove residual pancreatic necrotic tissue. No sign of abdominal compartment syndrome was noted. The patient has been discharged and resumed his previous work. The zipper technique and vacuum storage bag thus proved useful in providing postoperative care to a patient with infectious pancreatic necrosis accompanied by severe obesity.
