A 53-year-old male patient with a history of chronic alcoholism underwent emergency surgery for retrogastric perforation at the antropyloid junction of about 5 cm in diameter, which was repaired by primary closure.
The evolution is torpid, requiring multiple reoperations and maintenance of laparotomy.
In this context he developed a catastrophic abdomen, with the appearance of several enteroatmospheric fistulas with bilioenteric output, initially managed conservatively with closed therapy assisted by vacuum assisted closure (VAC) and closed enteral nutrition.
During its evolution, the patient was admitted to the ICU with multiple complications that made him use of vasoactive drugs to maintain hemodynamic stability, requiring long-term complications vasoactive drugs use, prolonged episodes of pneumonia associated with mechanical ventilation broad hepatomicrob.
One month after the beginning of the endoscopic retrograde cholangiopancreatography ERCP, the patient noticed that it had a distal occlusion.
When examining the laparotomy, it was evidenced the existence of an impacted EN area that justified the obstruction and a segment of intestine with signs of necrosis.
These findings were treated with emergency surgery, removing necrotic tissue and leaving two new fistulas.
The anatomopathological study revealed the existence of transmural necrosis of ischemic origin.
The postoperative course was fatal and she died a few weeks later due to septic shock of abdominal origin.
