Department of Internal Medicine, Daegu Fatima Hospital
ABSTRACT
Percutaneous endoscopic necrosectomy in acute severe pancreatitis with infected necrosis: a case report. Patients with acute infected necrotizing pancreatitis undergoing surgical management may have high risks of complications and mortality. Thus, as an alternative to surgical management, an endoscopic approach has been introduced. We report a case of successful treatment of acute severe pancreatitis with infected necrosis by percutaneous endoscopic necrosectomy (PEN). A 42-year-old man was hospitalized for acute pancreatitis resulting from biliary sludges. He had some fluid collections around the pancreas with severe epigastric pain. Emergency ERCP with EST was performed, and plastic stents were inserted into the bile duct and pancreatic duct for drainage. Despite using the antibiotics, fever developed with increased fluid collections and necrotic tissues which were found on the follow-up abdominal CT scan. Percutaneous catheter drainage (PCD) was performed, but fever did not go down even though several changes of catheter. We then performed the PEN through the opening of PCD. After four sessions of the procedure, much improvement was seen on the follow-up CT scan. With more research and progress, PEN will become a suitable alternative treatment for infected necrotizing pancreatitis
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