Complex Management of an Infected Pancreatic Collection With Walled-Off Necrosis in Acute Pancreatitis: A Case Report

A 38-year-old man, post a 17-day hospitalization for severe necrotizing pancreatitis (NP) with complications of a pancreatic collection and splenic vein thrombosis, presented to the emergency department with severe epigastric pain. Despite initial stability, abdominopelvic angio-CT revealed an enlarged pancreatic collection with active bleeding. Hemorrhagic shock ensued, leading to ICU admission and subsequent multiorgan failure, elevated intra-abdominal pressure, and suspected pancreatic collection infection. Endoscopic transluminal drainage (ETD) was performed, followed by empiric antibiotics, later adjusted to cefuroxime based on collection fluid cultures. The patient developed septic shock with Pseudomonas aeruginosa isolation in blood cultures, prompting targeted ceftazidime therapy. Repeat ETD with necrosectomy addressed the ongoing infection, with polymicrobial cultures necessitating an extended course of targeted antibiotics and antifungals. Clinical improvement ensued, culminating in discharge home. This case underscores the challenges in managing severe NP and highlights the efficacy of a multidisciplinary approach for improved patient outcomes.