Brief reportTransduodenal endoscopic necrosectomy via pancreaticoduodenal fistula for infected peripancreatic necrosis with left pararenal space extension (with videos)
Section snippets
Case report
A 43-year-old woman was admitted to our hospital for postprandial epigastric pain, nausea, generalized edema, and intermittent fever after ingesting a large amount of alcohol 2 weeks before admission. On admission, she had a fever of 38.5°C. A CT showed multiple necroses around the head, body, and tail of the pancreas, with multiple air bubbles, suggestive of infected peripancreatic necrosis or abscess. The patient was fasted. After blood cultures were obtained, broad-spectrum antibiotics were
Discussion
Transgastric necrosectomy is an alternative method of treatment for infected pancreatic necrosis or abscess.4 However, as in our case, the transgastric approach with or without EUS assistance may be difficult if gastric bulging is absent or the pocket of necrosis is out of range.4 Percutaneous drainage therapy might be an alternative method in this situation.8 In our case, the drainage was ineffective because of the solid nature of necrotic materials. Although a transduodenal approach may be
References (8)
- et al.
Outcome of open necrosectomy in acute pancreatitis
Pancreatology
(2003) - et al.
Early and late complications after pancreatic necrosectomy
Surgery
(2005) - et al.
Endoscopic therapy for organized pancreatic necrosis
Gastroenterology
(1996) - et al.
Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos)
Gastrointest Endosc
(2006)
Cited by (10)
Endoscopic Ultrasonography–guided Drainage of Pancreatic Collections, Including the Role of Necrosectomy
2017, Gastrointestinal Endoscopy Clinics of North AmericaCitation Excerpt :This technique combines percutaneous drain placement, used as the irrigation conduit, and endoscopic transmural drainage, for egress of debrided necrotic tissue. As mentioned earlier, spontaneous fistulous tracts can provide egress for liquefied debris and allow access for debridement of necrosis, in select cases.17 If possible, the tract should be balloon dilated to a diameter greater than or equal to 15 mm to allow egress of the remaining liquid and facilitate DEN.
Combined endoscopic and percutaneous drainage of organized pancreatic necrosis
2010, Gastrointestinal EndoscopyCitation Excerpt :In the case of the disconnected duct syndrome, however, each of these approaches may result in the formation of chronic pancreaticocutaneous fistulae in as many as 45% of patients.22 Endoscopic necrosectomy has also been reported.7-16 As opposed to surgical or percutaneous drainage, this technique has a low associated risk of pancreaticocutaneous fistulae.
Endoscopic management of pancreatic pseudocysts and necrosis
2015, Expert Review of Gastroenterology and HepatologyEndoscopic approach to pancreatic pseudocyst, abscess and necrosis: Review on recent progress
2012, Digestive Endoscopy