Case studyEndoscopic necrosectomy as primary treatment for infected peripancreatic fluid collections (with video)
Section snippets
Patients
Six consecutive patients (4 female, 2 male) underwent endoscopic necrosectomy between May 2006 and February 2007 as the primary treatment for pancreatic abscess or necrosis. The median age was 48 years (range 16-77 years). Infection was suspected if significant fever, abdominal pain, or leukocytosis were present in the right clinical setting or if CT imaging revealed a fluid collection with the presence of air without a spontaneous fistula. Contrast-enhanced abdominal CT was obtained in all
Results
Patient demographics and outcomes are detailed in Table 1. Four of the 5 patients had biliary pancreatitis. Endoscopic treatment was sought 4 to 6 weeks after the episode of pancreatitis because of enlarging fluid collections. Three patients had EUS drainage, and 1 had CT-guided tube placement before the development of pancreatic abscess. The median follow-up was 3.5 months (range 3-11 months).
All procedures were done by the transgastric approach. The fluid collections were entered at a site
Discussion
Pancreatic abscess can be defined as a contained collection of purulent material in proximity to the pancreas.18 Infected pseudocyst and infected pancreatic necrosis are included in this definition.19 Characteristically, a pancreatic abscess develops 3 to 4 weeks after the initial episode of pancreatitis. The basic tenet of treating any abscess is complete removal of necrotic material, pus and lavage of the cavity in addition to antibiotics. Management of pancreatic abscesses has traditionally
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