Endoscopic Retroperitoneal Necrosectomy for Infected Pancreatic Necrosis Using a Self-Expandable Metal Stent

Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient’s parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.

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Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience

Gastroenterology Research and Practice ◽

10.1155/2019/6069179 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Gang Li ◽

Lin Gao ◽

Jing Zhou ◽

Bo Ye ◽

Jingzhu Zhang ◽

...

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Splenic Artery ◽

Pancreatic Necrosis ◽

Splenic Abscess ◽

Arterial Embolization ◽

Massive Bleeding ◽

Massive Hemorrhage ◽

Single Center Experience

Objective. To describe the management and prognosis of splenic abscess after splenic arterial embolization in severe acute pancreatitis (SAP) patients.Methods. This is a retrospective observational study. From August 2012 to August 2017, SAP patients with infected pancreatic necrosis (IPN) who underwent splenic arterial embolization after massive hemorrhage of the splenic artery were screened and those who developed splenic abscess were included for analysis. The demographic characteristics, etiology, treatment of splenic abscess, and clinical outcomes of these cases were collected and analyzed.Results. A total of 18 patients with splenic abscess formed after splenic arterial embolization were included for data analysis. The median age of the 18 patients was 46 years. The etiologies included biliary AP, hypertriglyceridemic AP (HTG-AP), and other causes. Ten patients underwent minimally invasive percutaneous drainage only for splenic abscess while the other eight patients received splenectomy. One patient died due to uncontrolled infection and another patient died due to massive bleeding, and the remaining sixteen patients survived.Conclusion. The incidence of splenic abscess was high in patients requiring splenic arterial embolization due to massive bleeding. Our data showed that most splenic abscess could be successfully managed with minimally invasive interventions, and traditional splenectomy should serve as a backup treatment.

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Prognostic usefulness of scoring systems in critically ill patients with severe acute pancreatitis

Critical Care Medicine ◽

10.1097/00003246-199905000-00023 ◽

1999 ◽

Vol 27 (5) ◽

pp. 901-907 ◽

Cited By ~ 56

Author(s):

Martin Williams ◽

H. Hank Simms

Keyword(s):

Acute Pancreatitis ◽

Critically Ill ◽

Severe Acute Pancreatitis ◽

Critically Ill Patients ◽

Scoring Systems

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Minimally invasive techniques in the treatment of severe acute pancreatitis

Open Medicine ◽

10.2478/s11536-013-0283-1 ◽

2014 ◽

Vol 9 (4) ◽

pp. 580-587 ◽

Cited By ~ 1

Author(s):

Ignasi Poves ◽

Fernando Burdío ◽

Dimitri Dorcaratto ◽

Luis Grande

Keyword(s):

Acute Pancreatitis ◽

Surgical Treatment ◽

Minimally Invasive ◽

Severe Acute Pancreatitis ◽

Pancreatic Necrosis ◽

High Rate ◽

Multidisciplinary Teams ◽

Laparoscopic Transperitoneal ◽

Open Necrosectomy ◽

Invasive Techniques

AbstractOpen necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.

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Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis

Critical Care ◽

10.1186/cc12569 ◽

2013 ◽

Vol 17 (2) ◽

pp. R49 ◽

Cited By ~ 18

Author(s):

Alison M Hall ◽

Lee AL Poole ◽

Bryan Renton ◽

Alexa Wozniak ◽

Michael Fisher ◽

...

Keyword(s):

Acute Pancreatitis ◽

Critically Ill ◽

Severe Acute Pancreatitis ◽

Critically Ill Patients ◽

Candidal Infection

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Endoscopic Necrosectomy With Self-Expandable Metal Stent (SEMS) Drainage: A Novel Approach in the Treatment of Walled-Off Pancreatic Necrosis (WOPN)

Endoscopy ◽

10.1055/s-0031-1292126 ◽

2011 ◽

Vol 43 (S 03) ◽

Author(s):

E Joo

Keyword(s):

Pancreatic Necrosis ◽

Metal Stent ◽

Endoscopic Necrosectomy ◽

Novel Approach ◽

Self Expandable Metal Stent

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Multiple transluminal gateway technique with transplantation of lumen‐apposing metal stent for direct endoscopic necrosectomy in a patient with infected walled‐off pancreatic necrosis

Digestive Endoscopy ◽

10.1111/den.14014 ◽

2021 ◽

Author(s):

Takuji Iwashita ◽

Yuhei Iwasa ◽

Masahito Shimizu

Keyword(s):

Pancreatic Necrosis ◽

Metal Stent ◽

Endoscopic Necrosectomy

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HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

European Journal of Inflammation ◽

10.1177/20587392211000571 ◽

2021 ◽

Vol 19 ◽

pp. 205873922110005

Author(s):

Bei Lu ◽

Yang Cai ◽

Junjie Yin ◽

Jingrui Wang ◽

Zhong Jia ◽

...

Keyword(s):

Central Nervous System ◽

Acute Pancreatitis ◽

Nervous System ◽

Herpes Simplex ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Infected Pancreatic Necrosis ◽

Percutaneous Catheter Drainage ◽

Central Nervous System Complication ◽

Simplex Virus

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

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Transfer of a lumen-apposing metal stent to a different fistula for endoscopic necrosectomy of walled-off pancreatic necrosis

Endoscopy ◽

10.1055/a-1327-1993 ◽

2021 ◽

Author(s):

Koichiro Mandai ◽

Tetsuhisa Ko ◽

Koji Uno ◽

Kenjiro Yasuda

Keyword(s):

Pancreatic Necrosis ◽

Metal Stent ◽

Endoscopic Necrosectomy

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Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204446 ◽

2020 ◽

Vol 8 (11) ◽

pp. 4158

Author(s):

Pedro A. Alvarado-Bahena ◽

Enrique Chavez-Serna ◽

Jonatan Salgado-Vives ◽

Uraik F. Hernandez-Bustos ◽

Dante A. Saldivar-Vera ◽

...

Keyword(s):

Developing Countries ◽

Acute Pancreatitis ◽

Minimally Invasive ◽

Pancreatic Necrosis ◽

Late Complication ◽

Late Complications ◽

Open Approach ◽

Invasive Procedures ◽

Open Necrosectomy ◽

Level Hospital

Walled-off pancreatic necrosis is defined as a necrotic collection with a defined wall, which generally occurs in 15% of patients in the fourth week after acute pancreatitis. Actually, open surgery is reserved for selected cases, with minimally invasive treatments such as image-assisted percutaneous drainage or endoscopic ultrasound being the procedures of choice. However, in developing countries the open approach continues to be an effective therapeutic alternative. We present the case of a 47-year-old male patient with no significant history who developed severe acute pancreatitis secondary to hypertriglyceridemia and who later developed walled-off pancreatic necrosis as a late complication. As a treatment, a debridement of the necrotic tissue with marsupialization was performed using the bradley III technique, secondary to the procedure, a pancreatic fistula was developed. After 8 weeks of hospitalization, in which he had a favourable response to surgical treatment, with spontaneous closure of the fistula without complications. Surgical management of late complications of acute pancreatitis remains controversial. Although minimally invasive procedures are the first option nowadays, in developing countries, open necrosectomy remains a good option for the treatment of these types of complications.

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