Introduction Acute necrotising Pancreatitis with parenchymal and peripancreatic necrosis when infected results in significant morbidity and a high risk for mortality.Despite the advent of better accessories and equipment including the LAMS (lumen opposing metal stents), the timing of the intervention is always a question of debate. We are presenting this video capsule on early multimodal intervention in an adult male, with severe, infected extensive pancreatic necrotic collection.
Method This is a video case report describing the early multimodal therapy using Linear array echo-endoscope guided pseudocyst drainage with lumen opposing metal stent (NagiTM stent) and subsequent necrosectomy with gastroscope and polypectomy snare. Patient also had bilateral percutaneous pigtail drain placed under transabdominal ultrasound guidance.
Results A 30 year old adult male patient with Acute severe Pancreatitis, aetiology being alcohol. Patient was referred from a district hospital in view of severe necrotising pancreatitis.On week 3rd,a repeat abdominal imaging showed extensive pancreatic necrotic collection extending from the retroperitoneal space upto the pelvis and paracolic gutter with evidence of multiple air pockets within, no clear wall was formed yet around the necrotic collection. EUS guided cystogastrotomy using lumen opposing metal stent (NagiTM stent) was placed transmurally and simultaneously percutaneous transabdominal ultrasound guided pigtail were placed bilaterally to drain the paracolic gutters. Subsequently necrosectomy was performed over three sessions spaced over two weeks in between.Patient did not develop bleeding or any other major complications and was under cover of broad spectrum antibiotics for infected pancreatic necrosis. Healthy granulation tissue noted during the last session and the percutaneous drain was removed subsequently.Patient clinically improved and on followup.
Conclusion Early minimally invasive multimodal Endotherapy in the setting of infected extensive pancreatic necrosis facilitates to improve clinical outcome with less morbidity.Larger prospective randomised control trials comapring early and delayed interventions are necessary to validate the findings.
. Freeman ML, Werner J, van Santvoort HC, et al. International Multidisciplinary Panel of Speakers and Moderators. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas2012;41(8):1176–1194
Disclosure of Interest None Declared
- endoscopic necrosectomy
- eus cystogastrostomy
- necrotising pancreatitis