Walled-off pancreatic necrosis: a staged multidisciplinary step-up approach

Walled-off pancreatic necrosis (WOPN) is a rare complication of pancreatitis. We present the case of a woman in her eighties admitted for diffuse abdominal pain. She had a palpable abdominal mass and the CT scan showed necrosis throughout the tail of the pancreas, a peripancreatic and retrogastric h...

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Bibliographic Details
Published in:BMJ case reports 2020-03, Vol.13 (3), p.e232952
Main Authors: Sousa, Débora, Freitas Ferreira, Ana Carolina, Raimundo, Pedro, Maio, Rui
Format: Article
Language:English
Subjects:
Abdomen
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antibiotics
Case reports
Collections
Combined Modality Therapy
Cysts
Diagnosis, Differential
Endoscopy
Female
Gallstones
gastrointestinal surgery
Hepatitis
hepatitis and other GI infections
Humans
Medical imaging
Mortality
Necrosis
Pain
Pancreas
pancreas and biliary tract
Pancreatitis
Pancreatitis, Acute Necrotizing - drug therapy
Pancreatitis, Acute Necrotizing - surgery
Piperacillin, Tazobactam Drug Combination - therapeutic use
Surgery
Unusual Presentation of More Common Disease/Injury
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Summary:Walled-off pancreatic necrosis (WOPN) is a rare complication of pancreatitis. We present the case of a woman in her eighties admitted for diffuse abdominal pain. She had a palpable abdominal mass and the CT scan showed necrosis throughout the tail of the pancreas, a peripancreatic and retrogastric hydroaerial collection (19 cm of diameter) and a calculus in the main biliary duct, thus establishing a diagnosis of emphysematous necrotising obstructive pancreatitis. A step-up approach was decided, first with removal of the biliary calculus, followed by a waiting period of 4 weeks in which the patient was under intravenous antibiotics. At re-evaluation, the CT scan showed a smaller and more organised collection, bounded by a wall, defining WOPN. At this stage, transgastric drainage via echoendoscopy was attempted, without success, followed by percutaneous CT-guided drainage, also with little effect. Surgical necrosectomy was then executed, as a final step, with a successful outcome.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-232952