A Large Pancreatic Abscess Successfully Treated by Laparoscopy in a Bitch - A New Approach

Abstract

Background: Pancreatic abscesses are uncommon but potentially life-threatening complications of acute inflammatory pancreatitis in dogs. They consist in localized accumulations of purulent material and necrotic pancreatic tissue and are associated with substantial morbidity and mortality. Although surgical intervention is frequently required, conventional treatments such as debridement, excision, omentalization, and drainage are generally performed through open celiotomy and may be associated with prolonged hospitalization and postoperative complications. In human medicine, minimally invasive
approaches have become increasingly favored; however, to the authors’ knowledge, no veterinary report has described the complete laparoscopic treatment of a pancreatic abscess in dog. The aim of this report is to describe the successful laparoscopic management of a large pancreatic abscess in a bitch and its long-term outcome.
Case: A 12-year-old bitch mixed-breed, weighing 12 kg, was referred with a 3-week history of anorexia, vomiting, and yellowish diarrhea. Previous fecal examinations and treatments with metronidazole, sulfadimethoxine, and fenbendazole failed to produce clinical improvement. Hematological evaluation revealed mild anemia (hematocrit 29%, hemoglobin 12 g/dL) without leukocyte abnormalities. Abdominal ultrasonography identified a large hypoecoic cystic structure measuring approximately 10 cm in the hepatic-pancreatic region, and a 2 cm splenic nodule. Cytological evaluation of fluid obtained by ultrasound-guided aspiration demonstrated predominantly neutrophils, mesothelial cells, and macrophages, raising suspicion of a pancreatic abscess. Computed tomography was recommended but
declined by the owner. Exploratory laparoscopic approach was therefore elected. The procedure was performed using a three-port triangulation technique and a 30 ^o laparoscope. Intraoperatively, a large cystic structure was observed adherent to the greater omentum and gastric wall. After careful adhesiolysis, transparietal puncture and drainage were attempted, followed by opening of the abscess cavity, which allowed evacuation of approximately 500 mL of yellow purulent fluid. The abscess capsule was subsequently excised, and necrotic tissue was removed using an extraction bag introduced through a 11 mm portal. The cavity was extensively lavaged with sterile saline solution and omentalization was performed by securing the omentum within the cavity using titanium clips. Concurrent laparoscopic
biopsies of the splenic nodule were obtained. Histopathological examination confirmed necrotic pancreatic tissueassociated with degenerated neutrophils and fibrous tissue, supporting the diagnosis of pancreatic abscess. The splenic lesion was diagnosed as nodular lymphoid hyperplasia. Bacterial and fungal cultures yielded no microbial growth. The postoperative period was uneventful, and the dog was discharged 24 h after surgery. No abdominal pain, clinical abnormalities, or evidence of recurrence were detected during postoperative evaluations, including ultrasonographic assessment performed 2 years after the procedure.
Discussion: This report describes the 1 st successful laparoscopic treatment of a pancreatic abscess in a dog. The minimally invasive approach allowed effective drainage, debridement, excision of necrotic tissue, and omentalization without conversion to open surgery. Advantages observed included excellent visualization of abdominal structures, reduced tissue trauma, rapid postoperative recovery, and a short hospitalization period. Furthermore, the technique enabled simultaneous splenic biopsy, avoiding additional surgical intervention. Although extensive adhesions limited complete visualization of dorsal structures, the procedure achieved complete clinical resolution with no recurrence during long-term follow-up. These findings suggest that laparoscopy may represent a feasible and effective alternative
to conventional open surgery for selected cases of pancreatic abscess in clinically stable dogs and may contribute to reducing postoperative morbidity and hospitalization time.

Keywords: videosurgery, omentalization, titanium clips, pancreatic necrosis, capnoperitoneum, dog.