Isolation Before Manipulation: A Stepwise Strategy for Emergency Multivisceral Resection of Colosplenic Fistula

Area of Science:

• Surgical Oncology
• Gastroenterology
• Critical Care Medicine

Background:

• Colosplenic fistula (CSF) secondary to splenic flexure adenocarcinoma is a rare, life-threatening complication.
• Locally advanced adenocarcinoma can lead to fecalized splenic abscesses and septic shock, necessitating urgent intervention.

Purpose of the Study:

• To describe a structured, stepwise operative strategy for emergency multivisceral resection in a patient with CSF and splenic abscess.
• To highlight technical principles for safe and definitive source control in complex septic surgical fields.

Main Methods:

• Emergency multivisceral resection including distal pancreatectomy, splenectomy, left colectomy, and partial diaphragmatic resection.
• Emphasis on dissection through uninvolved planes, early vascular control, and sequential isolation of the inflammatory block.
• Reconstruction tailored to the patient's physiological status.

Main Results:

• Successful en bloc resection and definitive source control were achieved.
• Resolution of septic shock postoperatively.
• Management of a biochemical pancreatic fistula conservatively, leading to stable discharge.

Conclusions:

• A structured, stepwise operative strategy can facilitate safe emergency multivisceral resection for CSF.
• Technical principles emphasize minimizing contamination and hemorrhage in hostile septic fields.
• This approach offers a viable solution for definitive source control in complex cases.