Natural course of asymptomatic walled off pancreatic necrosis

Abstract

IntroductionThere is paucity of data on natural course of asymptomatic walled off necrosis (WON). ObjectiveTo study the natural course as well as outcome of conservative management in patients with asymptomatic WON. MethodsRetrospective analysis of prospectively maintained data base of patients with asymptomatic WON presenting to us 4–6 weeks after an episode of acute necrotising pancreatitis (ANP). ResultsForty three patients (37 M; mean age: 38.2 ± 10.4 years) with asymptomatic WON were studied. The size of WON ranged from 5 to 16 cm (mean 8.2 ± 2.2 cm). The site of WON was head, body and tail in 5 (11%), 34 (79%) and 4 (10%) patients respectively. Thirty of 43 patients (70%) patients did not have any complications during the expectant management period of 3 weeks–32 months with 13 (30%) patients having spontaneous resolution within 6.2 ± 3.4 months. Thirteen (30%) patients became symptomatic or developed complication within 3.2 ± 1.3 months. These were refractory pain (n = 7), infection (n = 4), spontaneous rupture into gastrointestinal tract (n = 5; stomach in 3, duodenum in 1 and colon in 1 patient respectively) and bleeding from splenic artery pseudoaneursym in 1 patient. ConclusionsMajority of patients with asymptomatic WON have an uneventful clinical course. However, one third patients will develop symptoms/complications requiring interventional treatment.