Effective percutaneous treatment of severe necrotizing pancreatitis: a case report

Abstract

Necrotizing pancreatitis (NP) is a severe form of acute pancreatitis associated with high morbidity and mortality. The management of infected necrotizing pancreatitis (INP) has evolved from open surgical necrectomy to minimally invasive techniques, such as percutaneous catheter drainage (PCD). We report the case of a 71-year-old male with a history of cholelithiasis who presented with acute abdominal pain, nausea, and vomiting. Initial imaging revealed an enlarged pancreas with peripancreatic fluid collections. Conservative treatment improved his condition, but nine days later signs of sepsis, including a persistent fever were presented. Computed tomography (CT) verified several large gas-containing fluid collections spreading from the pancreas to the left iliac crest along with bilateral pleural effusions. The patient underwent PCD with multiple drains inserted. Microbiological analysis showed Meropenem-resistant E. coli, leading to a change in antibiotic therapy. Follow-up imaging confirmed the resolution of fluid collections, and the patient recovered without requiring laparotomy. PCD has emerged as a crucial component of the step-up approach in managing INP. Compared with open necrectomy, PCD offers lower mortality and morbidity rates. The PAncreatitis, Necrosectomy versus sTEp up appRoach (PANTER) trial and subsequent studies have validated the efficacy of PCD, demonstrating its ability to reduce complications and healthcare costs while improving patient outcomes. PCD is a safe and effective treatment for INP, representing a valuable alternative to traditional surgical methods. This case underscores the importance of minimally invasive strategies in the management of NP.