Kissing catheter technique for percutaneous catheter drainage of necrotic pancreatic collections in acute pancreatitis

Abstract

One of the critical factors for predicting the success of percutaneous catheter drainage (PCD) is the mean CT density of collection. A higher CT density suggests more necrotic solid tissue within the collection. In the present study, a novel technique for PCD of the necrotic pancreatic collection with a higher mean CT density was evaluated. It was a retrospective study of patients with acute pancreatitis (AP) who underwent PCD of pancreatic collections between May 2018 and December 2018. Patients with pancreatic collections having a CT density of >30 Hounsfield Units (HU) were considered for PCD using the kissing catheter technique. This technique involved placing two catheters side-by-side through a single cutaneous entry site, as the conventional technique of PCD may not be effective. The technical details, outcomes and complications of this technique were recorded. A total of 10 patients with a mean age of 30 years underwent PCD using this technique. All patients had severe pancreatitis with a mean CT severity index of 9 (range, 8-10). The mean CT density was 37 HU (range, 32-56). Successful management with PCD alone was achieved in 8 patients. The other 2 patients underwent surgical necrosectomy. One patient who underwent surgical necrosectomy died. Minor complications occurred in 3 patients. The kissing catheter technique allows for a higher success rate of PCD compared with that of the conventional method of PCD, in collections with a higher mean CT density.

Keywords: acute pancreatitis; collections; percutaneous catheter drainage.

Figure 1

Images of a 22-year-old male with alcohol-induced acute pancreatitis with bilateral paracolic gutter collections managed with kissing catheter technique. (A) CT Scanogram displaying two catheters placed side-by-side in bilateral flanks (arrows). (B) Axial contrast-enhanced CT and (C) volume-rendered images from the CT study reveal the catheters placed in bilateral paracolic gutters through a single cutaneous opening (arrows).

Figure 2

Clinical images of the entry site of the kissing catheter and the necrotic debris. (A) Abdominal image of the patient, a 30-year-old male with alcohol-induced acute pancreatitis, subjected to percutaneous catheter drainage with the ‘kissing catheter’ technique; the two 14 F catheters placed side-by-side in the left paracolic gutter are displayed. (B) Image of the solid necrotic debris (measuring 4x2.8 cm) removed using this technique.