Abstract
Pancreatic pseudocysts and walled-off pancreatic necrosis arise as a complication of pancreatitis. Multiple fluid collections are seen in 5-20% of the patients who have walled-off peripancreatic fluid collections. There is a paucity of data regarding the role of endoscopic transmural drainage in the management of multiple pancreatic fluid collections. In this case report, we present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis. The patient underwent simultaneous endoscopic ultrasound-assisted cyst gastrostomy and cyst duodenostomy and aggressive irrigation without index endoscopic necrosectomy of the three peripancreatic fluid collections. Significant improvement in the size of the fluid collections was seen on the computed tomography scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention.
Highlights
Walled-off pancreatic fluid collections (PFCs) are fluid collections that arise as a consequence of pancreatic injury and complicate both acute and chronic pancreatitis
We present the case of a 72-year-old male with three walled-off pancreatic fluid collections in the setting of acute necrotizing pancreatitis
Pancreatic pseudocysts and walled-off pancreatic necrosis are peripancreatic fluid collections that arise as a consequence of pancreatic injury in acute and chronic pancreatitis
Summary
Walled-off pancreatic fluid collections (PFCs) are fluid collections that arise as a consequence of pancreatic injury and complicate both acute and chronic pancreatitis. The patient underwent simultaneous endoscopic ultrasound (EUS)-assisted cyst gastrostomy and cyst duodenostomy of the three WOPNs. Significant improvement in the size of the fluid collections was seen on the computed tomography (CT) scan, as well as a remarkable immediate clinical improvement after 24 hours of the endoscopic intervention. The collections were copiously irrigated with sterile water on index EUS intervention with plans for follow-up repeat necrosectomy This was followed by rapid improvement in the patient’s symptoms and discontinuation of total parenteral nutrition (TPN) within 72 hours as his diet was eventually progressed from clear liquids to solids. CT of the abdomen 24 hours post-endoscopic management showed the decreased size of peripancreatic fluid collections (Figure 1, row 3A-C). The patient was discharged five days post-procedure in stable condition
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