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Published on: January 3, 2020
Percutaneous treatment of a patient with infected necrotizing pancreatitis
Niels Zorger1, Okka W Hamer, Stefan Feuerbach
1Department of Radiology, University of Regensburg, Germany. nielszorger@aol.com
Background:
A 50-year-old man with an acute episode of alcohol-induced chronic edematous pancreatitis and an inflammatory stenosis of the biliary tract was treated by implantation of a plastic endoprosthesis at a rural hospital in Germany. Because of his worsening condition, the patient was referred to the intensive care unit of the University Hospital, Regensburg, Germany. Contrast-enhanced CT revealed complete necrosis of the body and tail of the pancreas, formation of large retrogastric and paraduodenal fluid collections, and fluid along Gerota's fascia, as well as in the paracolic gutters. Antibiotic treatment was adjusted according to the results of microbiological testing after diagnostic puncture of the necrotic cavity.
Investigations:
CT scan, CT-guided fine-needle aspiration and fluoroscopy.
Diagnosis:
Infected acute necrotizing pancreatitis.
Management:
Interventional treatment using large-bore percutaneous catheters to perform percutaneous necrosectomy, fragmentation of necrotic pancreatic tissue with a snare catheter and dormia basket, and aspiration. Parenteral nutrition and antibiotics were also administered.
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Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
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Acute Pancreatitis II: Clinical Manifestations and Management
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Assessment:
Acute Pancreatitis I: Introduction
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