Isolation Before Manipulation: A Stepwise Strategy for Emergency Multivisceral Resection of Colosplenic Fistula.
Olga Esepkina, Hila Shmilovich, Omri Sulimani et al.
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Case in brief
A 79-year-old patient with a colosplenic fistula from locally advanced splenic-flexure adenocarcinoma presented with septic shock and a fecalized splenic abscess involving the pancreatic tail. Prior diversion and nonresectional approaches had not achieved definitive source control. Emergency surgery included distal pancreatectomy, splenectomy, left colectomy, and partial diaphragmatic resection. Septic shock resolved after the operation; a biochemical pancreatic fistula was managed conservatively, and the patient was discharged in stable condition.
What made this case unusual
The fistula and fecalized splenic abscess extended to the pancreatic tail, requiring emergency multivisceral resection in a septic operative field after less extensive strategies had proved insufficient.
Diagnostic / clinical pearl
In this case, definitive source control required resection of the involved organs; the operative strategy isolated the inflammatory block before manipulation and maintained en bloc continuity.
Why it matters
The report illustrates operative principles intended to limit contamination and uncontrolled hemorrhage during emergency multivisceral resection in a hostile septic field.