A 54-year-old patient who came to the clinic due to an increase in PSA levels was recommended antibiotic treatment and further analysis.
After a result of 8 ng/ml, a prostatic biopsy was recommended.
The pathological result was prostate adenocarcinoma Gleason 3+3= 6, confirming localized disease with nuclear magnetic resonance.
The patient had a history of prior surgery for mental retardation and inguinal herniorrhaphy.
Surgical treatment by radical prostatectomy is proposed, being the access by retro-pituitary and extraperitoneal approach by Walsh technique, studying the intervention without incidents.
During the first days she presented fever peaks of up to 38.1oC, symptoms of postoperative paralytic ileus with abundant vomiting on the second day, suspending oral tolerance initiated on the first day.
On the fourth day, an abdominal X-ray was taken with the presence of gas in the colon and air-fluid levels in the right colon.
The discharge was planned for the eighth day given the satisfactory evolution.
On the seventh day, the patient presented with right flank pain and redness of the area with fever up to 39oC.
Abdominal CT showed a liquid collection with abundant gas located behind the second and third duodenal portions accompanied by minimal pneumoperitoneum, as well as retroperitoneal stenosis at the level of the descending colon.
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These findings suggest the existence of duodenal perforation in the retroperitoneal portion and infection, opting for conservative treatment.
Drainage was placed in the collection by ultrasound, obtaining fluid cultures, with growth of Staphylococcus haemolyticus and Candida albicans within days.
During admission he received empirical antibiotic treatment based on cultures.
A nasogastric tube was placed and parenteral oral feeding was suspected.
The collection was monitored by ultrasound, confirming the intestinal clicking with contrast in a gastroduodenal transit 30 days after the placement of the drainage, subsequently starting oral tolerance.
After good tolerance to food intake and apyretic status, a drainage tube was removed and the patient was discharged 45 days after surgery.
At 26 months she remains asymptomatic and with undetectable PSA.
