A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis

摘要

BACKGROUND： In approximately 20% of patients, necrotizing pancreatitis is complicatedwith severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-upapproach is both safe and effective, but sometimes requires multiple access sites.METHODS： A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computedtomography （CT） revealed no evidence of acute pancreatitis. She was clinically improved with insulintherapy, fl uid administration, and electrolyte replacement. However, on the 14th day of admission, shedeveloped a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with alarge collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14French gauge （Fr） pigtail catheter was placed 1 week later, which drained copious pus. Because ofpersistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters wereplaced via the initial drainage route, allowing the safe and effective drainage of the extensive necrotictissue that was occupying the bilateral anterior pararenal space.RESULTS： After drainage, the patient recovered well and the last catheter was removed on day123 of admission.CONCLUSIONS： Multiple percutaneous drainage requires both careful judgment and specialistskills. The perforation of the colon and small bowel as well as the injury of the kidney and majorvessels can occur. The current technique appears to be safe and minimally invasive compared withother drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.