Case Report Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy W. G. P. Kanchana , 1 A. D. Dharmapala , 1 B. K. Dassanayake, 1 W. M. A. S. B. Wasala, 2 and K. B. Galketiya 1 1 Department of Surgery, Teaching Hospital Peradeniya, Sri Lanka 2 Department of Anaesthesia and Critical Care, Teaching Hospital Peradeniya, Sri Lanka Correspondence should be addressed to W. G. P. Kanchana; pulasthi@live.com Received 2 February 2021; Revised 5 March 2021; Accepted 10 March 2021; Published 17 March 2021 Academic Editor: Claudio Feo Copyright © 2021 W. G. P. Kanchana et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4 th postoperative day. Conclusion. The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management. 1. Introduction Pancreatic fluid collections (PFC) are formed following epi- sodes of acute pancreatitis. PFC following interstitial oede- matous pancreatitis lead to pancreatic pseudocyst formation while acute necrotic collections (ANC) lead to the formation of walled-off necrosis (WON) after 4 weeks [1, 2]. Treatment strategy for PFC remains conservative in the acute phase unless infective complications lead to sys- temic effects and organ failure requiring control of sepsis [3]. Treatment of infected PFC depends on the haemody- namic stability and organ functions of the patient. Patients with no systemic complications are managed conservatively with antibiotics that penetrate pancreatic necrosis while drainage is recommended in patients with systemic effects that fail to improve with conservative measures [4]. Appro- priate timing of the decision to intervene is critical in these patients as late interventions in severely compromised patients lead to futile outcomes. Minimal invasive approaches are preferred in these patients as the systemic inflammatory response of a surgical intervention may drag the already compromised systemic reserves to their limits. But in a patient with free peritoneal perforation of a PFC, options available for control of sepsis Hindawi Case Reports in Surgery Volume 2021, Article ID 5532096, 4 pages https://doi.org/10.1155/2021/5532096