VIDEO-ASSISTED NECROSECTOMY IN OMENTAL NECROSIS – A CASE REPORT

Introduction Video-assisted retroperitoneal necrosectomy (VAN) involves the insertion of a drainage tube via a transperitoneal approach to perform lavage and debridement of the necrotic area. This procedure is widely used and established in cases of necrotizing pancreatitis with satisfactory outcomes.

Method A study based on medical record analysis and literature review aimed at describing a case of omental infarction resolved uniquely by video-assisted necrosectomy.

Case Report A 52-year-old male patient with dyslipidemia presented a single episode of lower gastrointestinal bleeding in December 2023. A computed tomography (CT) scan of the abdomen showed a thickened area in the splenic flexure of the colon with infiltration of adjacent fat, and a colonoscopy with biopsy fragments was performed. The subsequent histopathological report indicated poorly differentiated adenocarcinoma. Further staging exams showed no significant changes. In January 2024, the patient underwent robotic left colectomy with satisfactory progress and was discharged on the 3rd postoperative day. However, 8 days later, the patient returned with fever and abdominal pain. New exams revealed ischemia and omental necrosis, initially treated conservatively with antibiotics, followed by CT-guided puncture for the placement of a pigtail drain to evacuate the collection in the necrotic area. After two months of conservative management without complete improvement and the inability to start chemotherapy due to septic conditions, the decision was made to perform video-assisted necrosectomy, which resulted in significant improvement and enabled the possibility of chemotherapy.

Discussion The choice of an additional procedure, in this case, video-assisted debridement, depends on the location of the collection relative to adjacent organs, availability of methods and technologies, time of presentation, appearance of the content, and the patient’s clinical condition.

Conclusion VAN proved to be potentially effective and feasible, and it can be implemented in cases of omental necrosis, even though its indication is more firmly established in pancreatic necrosis. As a minimally invasive procedure, it offers rapid recovery, avoids conventional procedures, and allows surgeons who are not fully skilled to achieve clinical resolution with lower risks.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025