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Case Reports
. 2015 Jul-Sep;4(3):257-9.
doi: 10.4103/2303-9027.163019.

Creation of multiple transluminal gateway during endoscopic ultrasound-guided drainage of pancreatic necrosis by enlarging tract of impending rupture in duodenum

Surinder Singh Rana  1 , Vishal Sharma, Suresh Gorka, Ravi Sharma, Deepak Kumar Bhasin
Affiliations
Case Reports

Creation of multiple transluminal gateway during endoscopic ultrasound-guided drainage of pancreatic necrosis by enlarging tract of impending rupture in duodenum

Surinder Singh Rana et al. Endosc Ultrasound. 2015 Jul-Sep.

Abstract

Necrotic pancreatic collections are difficult to treat endoscopically due to a concern for inadequate drainage of the necrotic debris. Multiple techniques including the use of metallic stents, endoscopic necrosectomy and use of hybrid approaches utilizing endoscopic and percutaneous approaches have been described for the management of pancreatic necrotic collections. Furthermore, multiple transluminal gateway technique has been used to create endosonography guided multiple tracts to drain a perigastric or periduodenal collection. We hereby report about a patient with walled off necrosis resulting as a complication of alcohol related acute pancreatitis that was drained using endoscopic ultrasound-guided approach. However, a spontaneous cystoduodenal fistula was used to create another tract and place transmural stents resulting in a quick resolution of symptoms.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Computed tomography abdomen: Large walled off pancreatic necrosis (WOPN) in perigastric and periduodenal location. The small perigastric collection is communicating with the large perigastric WOPN
Figure 2
Figure 2
Endoscopic ultrasound guided drainage of perigastric walled off pancreatic necrosis. The tract being dilated with balloon (arrows)
Figure 3
Figure 3
Small opening plugged with purulent material noted on the medial wall of duodenum (blue arrow)
Figure 4
Figure 4
The opening being cannulated. Major papilla can be seen (arrow). Purulent material seen coming out of the opening
Figure 5
Figure 5
Balloon dilatation of the opening
Figure 6
Figure 6
Multiple transluminal stents in perigastric (white arrow) and periduodenal walled off pancreatic necrosis seen (black open arrow). Transpapillary pancreatic duct stent also seen (black arrow)
See this image and copyright information in PMC

References

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