Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jan 8;16(1):e51889.
doi: 10.7759/cureus.51889. eCollection 2024 Jan.

Infected Walled-Off Necrosis Following COVID-19-Associated Acute Pancreatitis

Shota Yagi  1   2 , Hideki Miwa  1 , Yosuke Kobayashi  3 , Kenta Mitsusada  4
Affiliations
Case Reports

Infected Walled-Off Necrosis Following COVID-19-Associated Acute Pancreatitis

Shota Yagi et al. Cureus. .

Abstract

A 54-year-old man was admitted for fever and dyspnea. He presented with severe COVID-19 pneumonia and elevated amylase and lipase levels. He received treatment for COVID-19 and possible acute pancreatitis (AP). Although pneumonia and amylase levels improved, a high-grade fever persisted. On day 39, abdominal CT revealed heterogenous liquid and non-liquid components with a well-defined wall around the pancreas, and he was diagnosed with infected walled-off necrosis (WON) after AP. It was concluded to be associated with COVID-19 because there were no identifiable causes, such as alcohol consumption, gallstones, or other viral infections. The necrotic collection and fever improved after endoscopic transgastric drainage and necrosectomy. SARS-CoV-2 is becoming recognized as a new etiological infectious factor for AP, and COVID-19-associated AP shows higher severity and mortality. Clinicians should evaluate COVID-19 patients for concomitant AP, and if it is present, they should carefully monitor the development of local complications, including WON.

Keywords: acute pancreatitis; covid-19; idiopathic pancreatitis; sars-cov-2; walled-off necrosis.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Chest and abdominal CT scans on admission
(A) Chest CT scan shows bilateral ground-glass opacities and consolidation in both lungs. (B) Abdominal CT scan reveals normal gall bladder and biliary tract, with unremarkable pancreas CT: computed tomography
Figure 2
Figure 2. Clinical course after admission
Although the respiratory and renal impairments gradually improved, high-grade fever persisted until treatment for WON was initiated MCFG: micafungin; MEPM: meropenem; mPSL: methylprednisolone; PSL: prednisolone; WON: walled-off necrosis
Figure 3
Figure 3. Abdominal CT scans at diagnosis of WON
CT scans of the abdomen show a heterogenous collection showing liquid and non-liquid components with a well-defined wall around the pancreas (white arrow) CT: computed tomography, WON: walled-off necrosis
Figure 4
Figure 4. Changes in abdominal CT scans after initiation of treatment for WON
(A) Endoscopic ultrasound-guided transgastric drainage using a lumen-apposing metal stent did not improve encapsulated collection significantly (day 98). (B) A follow-up CT after endoscopic necrosectomy shows marked improvement in the encapsulation collection (day 195) CT: computed tomography, WON: walled-off necrosis
See this image and copyright information in PMC

References

    1. Frequency of five unusual presentations in patients with COVID-19: results of the UMC-19-S(1) Miró Ò, Llorens P, Jiménez S, et al. Epidemiol Infect. 2020;148:0. - PMC - PubMed
    1. Acute pancreatitis. Forsmark CE, Vege SS, Wilcox CM. N Engl J Med. 2016;375:1972–1981. - PubMed
    1. Prevalence, risk factors, and outcomes of hospitalized patients with coronavirus disease 2019 presenting as acute pancreatitis. Inamdar S, Benias PC, Liu Y, Sejpal DV, Satapathy SK, Trindade AJ. Gastroenterology. 2020;159:2226–2228. - PMC - PubMed
    1. COVID-19 and acute pancreatitis: examining the causality. de-Madaria E, Capurso G. Nat Rev Gastroenterol Hepatol. 2021;18:3–4. - PMC - PubMed
    1. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Banks PA, Bollen TL, Dervenis C, et al. Gut. 2013;62:102–111. - PubMed

Publication types

LinkOut - more resources