Infected retroperitoneal pelvic necrosis in severe acute pancreatitis: how can we manage it?

Retroperitoneal necrosis in the pelvic cavity is a rare complication of severe acute pancreatitis (SAP), mainly developing in critically ill patients. Because of its particular anatomy, it is difficult to perform drainage or surgery. We hypothesized that computed tomography (CT)-guided drainage is an effective approach for the infected retroperitoneal necrosis. The aim of this study is to evaluate the safety and effectiveness of CT-guided transgluteal drainage in SAP patients with infected retroperitoneal pelvic necrosis.

Twelve SAP patients with infected retroperitoneal pelvic necrosis underwent CT-guided transgluteal drainage with a 12-month follow-up. The safety and effectiveness of drainage were measured by the complication rate and the rate of clinical success.

All the 12 patients underwent a successful drainage under the guidance of CT and their clinical symptoms disappeared within 48 h. One patient died of another serious complication of SAP and in the remaining 11 patients, complete resolution was achieved without major complications. The mean catheter indwelling time was 21.5 days. Repeated CT during the follow-up period showed no recurrence in the remaining 11 patients.

Transgluteal drainage under the guidance of CT was found to be an effective and appropriate approach for infected pelvic necrosis in SAP patients.