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Percutaneous treatment of a patient with infected necrotizing pancreatitis

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 54–57 (2005)Cite this article

Abstract

Background A 50-year-old man with an acute episode of alcohol-induced chronic edematous pancreatitis and an inflammatory stenosis of the biliary tract was treated by implantation of a plastic endoprosthesis at a rural hospital in Germany. Because of his worsening condition, the patient was referred to the intensive care unit of the University Hospital, Regensburg, Germany. Contrast-enhanced CT revealed complete necrosis of the body and tail of the pancreas, formation of large retrogastric and paraduodenal fluid collections, and fluid along Gerota's fascia, as well as in the paracolic gutters. Antibiotic treatment was adjusted according to the results of microbiological testing after diagnostic puncture of the necrotic cavity.

Investigations CT scan, CT-guided fine-needle aspiration and fluoroscopy.

Diagnosis Infected acute necrotizing pancreatitis.

Management Interventional treatment using large-bore percutaneous catheters to perform percutaneous necrosectomy, fragmentation of necrotic pancreatic tissue with a snare catheter and dormia basket, and aspiration. Parenteral nutrition and antibiotics were also administered.

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Figure 1: Results of CT scans.
Figure 2: Fluoroscopic image before percutaneous necrosectomy.
Figure 3: The snare catheter and dormia basket used in the extraction of necrotic tissue.

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Author information

Authors and Affiliations

  1. fifth-year residents Department of Radiology, University of Regensburg, Germany

    Niels Zorger & Ingitha Borisch

  2. fourth-year resident Department of Radiology, University of Regensburg, Germany

    Okka W Hamer

  3. Chief of the Department of Radiology, University of Regensburg, Germany

    Stefan Feuerbach

Authors
  1. Niels Zorger
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  2. Okka W Hamer
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  3. Stefan Feuerbach
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  4. Ingitha Borisch
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Corresponding author

Correspondence to Niels Zorger.

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Competing interests

The authors declare no competing financial interests.

Glossary

GEROTA'S FASCIA

Fibroareolar tissue and fat that surrounds the kidney

PARACOLIC GUTTERS

The grooves between the lateral aspect of the ascending or descending colon and the abdominal wall

LESSER SAC

A cavity behind the stomach and duodenal bulb; also know as the bursa omentalis minor

CLOSED PACKING

Operative necrosectomy followed by drainage of the cavity with stuffed Penrose and closed suction drains

SELDINGER TECHNIQUE

A method by which a catheter is percutaneously inserted into a blood vessel or space, such as an abscess cavity

PEEL-AWAY SHEET

A sheet that can be removed without replacing the drainage catheter

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Zorger, N., Hamer, O., Feuerbach, S. et al. Percutaneous treatment of a patient with infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol 2, 54–57 (2005). https://doi.org/10.1038/ncpgasthep0082

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  • DOI: https://doi.org/10.1038/ncpgasthep0082

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