I will appreciate your opinion about this case,
42 y.o man presents with 1 week history of pain in the left groin.
Physical examination-symptomatic left groin mass, hard, fixed, touching-painful.
Temp.38 C, WBC-18 000, Lipase, Amylase, Bilirubin, Electrolyte-normal.
The patient has multiple risk factors: obese, smoker-50/day, beer-10/day.
Emergency Op-incarcerate Hernia.
However, in the operation I did not find neither incarcerate hernia or groin
hernia. I found only necrotic fat tissue in the groin.
Lower midline incision-minimal abdominal fluid-(bacteriology negativ), extensive
necrosis of retroperitoneal fat and mesentery on the left side, pancreas
swollen. Drain, antibiotics-intraop, intravenous nutrition postop.
Post Op abdomen CT-Pancreatitis with necrosis of retroperitoneal fat.
Lab.Lipase, amylase normal, WBC 10 ooo.
The patient is asymptomatic and he seems to be doing well, for now.
What would you recommend now ? Options,
2.Conservative policy of management -antibiotic, intravenous nutrition
3.Early debridement of necrosis
4.any other suggestions ?