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

Colosplenic fistula (CSF) secondary to locally advanced splenic flexure adenocarcinoma is a rare but life-threatening cause of septic shock requiring urgent source control. We describe a structured stepwise operative strategy for emergency multivisceral resection in a 79-year-old patient with CSF and a fecalized splenic abscess involving the pancreatic tail, in whom prior diversion and nonresectional strategies were insufficient for definitive source control. The operation emphasized dissection through uninvolved tissue planes, early vascular control, sequential isolation of the inflammatory block before manipulation, preservation of en bloc continuity, and reconstruction tailored to the patient's physiological status. Emergency distal pancreatectomy, splenectomy, left colectomy, and partial diaphragmatic resection were successfully performed. Postoperative recovery was marked by resolution of septic shock and a biochemical pancreatic fistula managed conservatively, allowing discharge in stable condition. This report highlights technical operative principles that may facilitate safe definitive source control while minimizing contamination and uncontrolled hemorrhage during emergency multivisceral resection in hostile septic operative fields.