Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

Abstract

Aim: To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis (SAP).

Methods: A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization. An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d. The sinus tract of the drainage catheter was expanded gradually with a skin expander, and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d. Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.

Results: Among the 42 patients, the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts. No death and complication occurred during the procedure.

Conclusion: Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple, safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

Figure 1

Ultrasound-guided percutaneous puncture and catheter drainage. A: An 18-G puncture needle is inserted into the peripancreatic focus under the guidance of ultrasound with a guidewire placed in the focus through the puncture needle lumen; B: An 8-Fr drainage catheter is immediately delivered into the focus along the guidewire after adequate expansion of abdominal wall layers.

Figure 2

Replacement of the drainage catheter with a larger-diamete drainage tube. A: Gradual expansion of the drainage catheter sinus tract using different Fr skin expanders along with the guidewire; B: Pulling out the expander with its sheath left in the focus after insertion of a sheath matching the 24-Fr skin expander into the focus; C: Insertion of a 22-Fr drainage tube into the focus through the sheath lumen of a skin expander; D: Left in the focus.

Figure 3

Debridement guided by choledochoscope. Formation of sinus tract around the drainage tube (A) with a choledochoscope slowly inserted into the focus through the sinus tract (B) 7 d after drainage with a large drainage tube, flushing of accumulated pus and necrotic tissue fragments from the foci of SAP by injecting a large amount of sterile saline and 0.5% metronidazole into the infected foci via the water inlet of choledochoscope (C).