In recent days, the Gastroenterology Department, in collaboration with multiple disciplines, successfully saved a patient suffering from acute hemorrhagic necrotizing pancreatitis. This form of pancreatitis is characterized by its severity, rapid progression, and high incidence of complications, leading to a heightened mortality rate. After over 40 days of treatment and meticulous care, the patient has made a robust recovery and has been discharged.

Recurrent Condition Necessitates Emergency Multidisciplinary Consultation

The patient, a 67-year-old male with a history of hypertension, started experiencing upper abdominal pain over 50 days ago. He was initially diagnosed with severe pancreatitis at a local hospital. Despite seeking treatment at multiple hospitals, his symptoms persisted. Eventually, he sought treatment at the Second Hospital of Shandong University's Gastroenterology Department due to its reputable expertise in the field.

Upon admission, the department took proactive measures to suppress pancreatic secretions, administer fluid therapy, and initiate anti-infective treatment, resulting in an amelioration of the patient's symptoms. However, 20 days ago, the patient's condition suddenly deteriorated, with intensified abdominal pain and distension, coupled with persistent high-grade fever. Total bilirubin levels soared to seven times the upper limit of normal, and glutamyl transpeptidase levels escalated to 17 times the upper limit of normal. The patient had begun to exhibit signs of impending liver failure, carrying an extremely elevated risk of mortality. CT scans indicated acute hemorrhagic necrotizing pancreatitis, accompanied by a substantial peripancreatic fluid accumulation, suggesting a pseudocyst causing obstructive jaundice, along with severe bacteremia, pleural effusion, and type I respiratory failure.

Currently, the patient is grappling with multi-organ dysfunction, facing imminent threats of acute respiratory distress syndrome and septic shock. Deputy Director Xu Weihua and Chief Physician Wang Hongjuan, both eminent figures in the department, swiftly orchestrated a comprehensive consultation that encompassed Gastroenterology, Interventional and Minimally Invasive Oncology, Hepatobiliary Surgery, Gastrointestinal Surgery, and various other specialized fields. Followingmeticulous deliberation, the consensus was to promptly commence treatment for jaundice alleviation.

Triumphing Through Each Obstacle. Finally Discharged on the Path to Recovery

At this point, the patient's duodenum exhibits significant edema and luminal narrowing, making it impossible to insert a biliary stent.TheDepartment of Interventional and Minimally Invasive Oncology, led by Doctor Yu Zhe, performed an emergency percutaneous transhepatic biliary drainage procedure. Postoperatively, the patient continued to experience high fever and was subsequently transferred to the Intensive Care Unit for aggressive treatment, including anti-infection measures, nutritional support, suppression of pancreatic enzyme secretion, and drainage of pleural effusion.

The patient's blood and bile cultures revealed the presence of Enterococcus faecium, necessitating the inclusion of Vancomycin in the treatment regimen following sensitivity analysis. This adjustment resulted in a notable decrease in the patient's temperature. Subsequently, the patient was transferred to the Gastroenterology ward for continued care and treatment.

Saving a life is akin to navigating a treacherous obstacle course, with each stage fraught with challenges and peril. Throughout the hospitalization period, the patient's condition fluctuated repeatedly. The Department of Gastroenterology collaborated with various disciplines for consultations, promptly assessing the patient's condition and implementing tailored measures, ultimately saving the patient's life. The patient requires a gastric tube, jejunal nutrition tube, urinary catheter, gallbladder drainage tube, and thoracic drainage tube. Caregivers provided meticulous attention to prevent dislodgement and infection. Under the attentive care of the medical staff, the patient successfully navigated a series of obstacles, including severe infection, shock, abdominal compartment syndrome, and multi-organ failure. At present, the patient is recovering well and can be discharged with the gallbladder drainage tube in place. Upon discharge, the medical team thoroughly informed the patient of post-discharge instructions, and close follow-up will be maintained.

Patients with acute severe pancreatitis face a precarious prognosis, with a high incidence of complications and mortality. Particularly for those experiencing rapid onset of multi-organ dysfunction, the success rate of treatment is low. The successful treatment of this patient highlights the hospital's exceptional medical expertise and the advantages of multidisciplinary consultations. Empowered by the multidisciplinary approach, the Second Hospital of Shandong University continues to enhance its capability in treating critically ill patients. The hospital is committed to elevating the standard of diagnosis and treatment, better serving the health needs of the population in Jinan and its surrounding areas.