Percutaneous treatment of a patient with infected necrotizing pancreatitis

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.