Experience in treatment of 1 patient with peripancreatic walled-off necrosis after severe acute pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DUAN Jun ^1,2 , GONG Jianping ¹ , DENG Tao ² ,  LIU Yiming ¹

1. Department of Hepatobililary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;
2. Department of General Surgery, Hospital of Traditional Chinese Medicine, Yongchuan, Chongqing 402160, P. R. China;

Corresponding author：

LIU Yiming, Email: ncisgibbs@163.com

Keywords：

severe acute pancreatitis; peripancreatic walled-off necrosis; percutaneous sinus tract necrosectomy; multi-disciplinary team

DOI：

10.7507/1007-9424.201904030

Video：

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Objective To investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.Methods The clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.Results The patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.Conclusions SAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.

Citation： DUAN Jun, GONG Jianping, DENG Tao, LIU Yiming. Experience in treatment of 1 patient with peripancreatic walled-off necrosis after severe acute pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 847-851. doi: 10.7507/1007-9424.201904030 Copy

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2.	van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut, 2017, 66(11): 2024-2032.
3.	王雪峰. 内镜在急性胰腺炎中治疗价值评价. 中国普外基础与临床杂志, 2015, 22(1): 5-7.
4.	Huber W, Algül H. Treatment of acute necrotizing pancreatitis. Internist (Berl), 2019, 60(3): 226-234.
5.	Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.
6.	Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med, 2016, 375(20): 1972-1981.
7.	Li J, Chen J, Tang W. The consensus of integrative diagnosis and treatment of acute pancreatitis—2017. J Evid Based Med, 2019, 12(1): 76-88.
8.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
9.	何文华, 吕农华. 亚特兰大急性胰腺炎分类国际共识2012年修订解读. 中国实用内科杂志, 2013, 33(9): 709-11.
10.	孙翰, 柏小寅, 吴东. 急性胰腺炎早期干预的时效性. 协和医学杂志, 2019, 1(8): 15-22.
11.	Koutroumpakis E, Slivka A, Furlan A, et al. Management and outcomes of acute pancreatitis patients over the last decade: A US tertiary-center experience. Pancreatology, 2017, 17(1): 32-40.
12.	姜春晖杜奕奇. 亟需重视重症急性胰腺炎中后期并发症防治. 内科急危重症杂志, 2019, 25(1): 5-9.
13.	Bakker OJ, Issa Y, van Santvoort HC, et al. Treatment options for acute pancreatitis. Nat Rev Gastroenterol Hepatol, 2014, 11(8): 462-469.
14.	Hollemans RA, van Brunschot S, Bakker OJ, et al. Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Rev Med Devices, 2014, 11(6): 637-648.
15.	吕新建, 孔瑞, 孙备. 坏死性胰腺炎外科干预方式研究进展. 中国实用外科杂志, 2018, 38(2): 231-234.
16.	van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet, 2018, 391(10115): 51-58.
17.	van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
18.	Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1016-1026.
19.	Makris GC, See T, Winterbottom A, et al. Minimally invasive pancreatic necrosectomy; a technical pictorial review. Br J Radiol, 2018, 91(1082): 20170435.

1. Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute Guideline on initial management of acute pancreatitis. Gastroenterology, 2018, 154(4): 1096-1101.
2. van Dijk SM, Hallensleben NDL, van Santvoort HC, et al. Acute pancreatitis: recent advances through randomised trials. Gut, 2017, 66(11): 2024-2032.
3. 王雪峰. 内镜在急性胰腺炎中治疗价值评价. 中国普外基础与临床杂志, 2015, 22(1): 5-7.
4. Huber W, Algül H. Treatment of acute necrotizing pancreatitis. Internist (Berl), 2019, 60(3): 226-234.
5. Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.
6. Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med, 2016, 375(20): 1972-1981.
7. Li J, Chen J, Tang W. The consensus of integrative diagnosis and treatment of acute pancreatitis—2017. J Evid Based Med, 2019, 12(1): 76-88.
8. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
9. 何文华, 吕农华. 亚特兰大急性胰腺炎分类国际共识2012年修订解读. 中国实用内科杂志, 2013, 33(9): 709-11.
10. 孙翰, 柏小寅, 吴东. 急性胰腺炎早期干预的时效性. 协和医学杂志, 2019, 1(8): 15-22.
11. Koutroumpakis E, Slivka A, Furlan A, et al. Management and outcomes of acute pancreatitis patients over the last decade: A US tertiary-center experience. Pancreatology, 2017, 17(1): 32-40.
12. 姜春晖杜奕奇. 亟需重视重症急性胰腺炎中后期并发症防治. 内科急危重症杂志, 2019, 25(1): 5-9.
13. Bakker OJ, Issa Y, van Santvoort HC, et al. Treatment options for acute pancreatitis. Nat Rev Gastroenterol Hepatol, 2014, 11(8): 462-469.
14. Hollemans RA, van Brunschot S, Bakker OJ, et al. Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Rev Med Devices, 2014, 11(6): 637-648.
15. 吕新建, 孔瑞, 孙备. 坏死性胰腺炎外科干预方式研究进展. 中国实用外科杂志, 2018, 38(2): 231-234.
16. van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet, 2018, 391(10115): 51-58.
17. van Grinsven J, van Santvoort HC, Boermeester MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312.
18. Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1016-1026.
19. Makris GC, See T, Winterbottom A, et al. Minimally invasive pancreatic necrosectomy; a technical pictorial review. Br J Radiol, 2018, 91(1082): 20170435.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experience in treatment of 1 patient with peripancreatic walled-off necrosis after severe acute pancreatitis

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